A pectoralis major axial pattern flap used to fill a shoulder or upper arm defect may be effective and reliable, but it may further debilitate the function of the extremity in a thirty year old construction worker. The 90 year old non-ambulatory patient with a sacral decubitus ulcer may suffice with a skin graft that is quick and effective in providing a healed wound. Operative time is minimal leading to less anesthesia time and blood loss. Donor site morbidity would be limited. In this case, an axial or large random pattern flap involves a more sophisticated technique, but the patient should expect a more acceptable result in the long run.
Reconstructive principles continue to evolve and some techniques are still in their infancy.
Surgeons must determine the ideal method for each scenario. Presently, this involves the transfer of tissue from one part of the body to reconstruct another with the goal of over-all improvement. As we learn and develop newer methods of reconstruction and flap design, we find that several alternatives may all provide improved outcome. This is where art and ingenuity come into play. With careful documentation and evaluation of the methods chosen to date, we as a society should expect continual improvement and should expect nothing less.