Reconstructive surgery can be required as a result of complex wounds and tissue defects, which can occur after various types of injuries and surgical procedures. Tissue may need to be transferred to the affected area to restore form and function as much as possible, which can be done in several ways. Local muscle flaps have been used frequently for the reconstruction of various wounds and tissue defects historically, but questions remain regarding the outcomes after the use of specific muscle flaps in the short- as well as the long-term perspective. In this thesis different outcome perspectives are studied in patient groups who had reconstructive surgery with local muscle or musculocutaneous flaps in Linköping University Hospital due to complex wounds or tissue defects.

In paper I, the outcomes after sternal reconstruction using a unilateral pectoralis major advancement flap following deep sternal wound infection (DSWI) were evaluated. The results of the study show that the sternal reconstruction was successful in most cases and contributed to healing of the infection. Surgical complications were however relatively common, and some patients required reoperations due to complications.

Paper II investigated the outcomes after reconstruction of deep pressure ulcers in the pelvic area using local musculocutaneous and fasciocutaneous flaps, in a patient cohort in which the majority had spinal cord injury (SCI). Flap viability was compared between different types of flaps and techniques. The results of the study conclude that musculocutaneous and fasciocutaneous flaps have similar viability and that a certain type of flap was associated with an increased risk of flap failure.

In paper III, long-term outcomes after breast reconstruction following breast cancer using the extended latissimus dorsi myocutaneous flap were evaluated, using the patient-reported outcome measure (PROM) BREAST-Q. The results of the study show a high level of long-term patient satisfaction following this method of breast reconstruction, which seems to increase over time.

Paper IV investigated long-term outcomes following reconstruction of complex wounds around the foot and ankle using the extensor digitorum brevis (EDB) muscle flap. Outcomes were assessed using both PROMs and functional measurements. Overall, the results of the study show that foot and ankle function does not appear to be significantly affected by the harvest of the EDB muscle flap.

In summary, patients who have had reconstructive surgery with muscle flaps constitute a complex heterogeneous group. The studies in this thesis add knowledge regarding short- and long-term outcomes after reconstructive surgery using specific muscle flaps, which can be valuable when considering the appropriate surgical method for the individual patient.