Final answer:
The use of a pedicled myocutaneous flap or a free myocutaneous flap is most appropriate for wound closure in a breast reconstruction procedure, as they provide the necessary volume and vascular supply that is not available with skin grafts.
Step-by-step explanation:
The most appropriate method of wound closure for a 59-year-old lady who has undergone breast reconstruction with a breast implant placed anterior to the pectoralis major would be the use of a pedicled myocutaneous flap or a free myocutaneous flap. These flaps are composed of skin, fat, and muscle with an intact blood supply, which are ideal for reconstructive procedures. In contrast, skin grafts are typically used for repairing defects that do not require the volume or vascular supply provided by a myocutaneous flap. A full-thickness skin graft involves the transplantation of the epidermis and the entire thickness of the dermis, while a split-thickness skin graft includes the epidermis and part of the dermis.