DISCUSSION
External oblique myocutaneous flap was used for the first time in the 1950s for the coverage of a lower abdominal wall defect.3 Lately , the EOM flap has found its utility in the closure of skin defects of the chest wall following radical mastectomy and post-radiation necrosis.2 The EOM is well vascularized as a type V muscle with both a single dominant blood supply and multiple segmental supply. The dominant supply of the flap is from the perforators arising from deep circumflex iliac artery, and the segmental supply arises via perforators from 5th to 12th posterior intercostal arteries.4
The harvest of EOM flap is technically easy and safe, as no major neurovascular structures arise in the area of dissection. It can be done in the supine position at the same setting. It allows for healing of wound by primary intention and the donor site can be closed primarily. Previous studies have mentioned successful coverage of skin defects upto 500 to 600 square cm.5 The largest defect filled in our series was 528 square centimeter.
In Nepalese context wherein patients often present with advanced breast cancer amidst a resource constrained environment, we have found the utility of the EOM flap to be of paramount significance. It is practical, straightforward and has consistently produced good results in our small case series.