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. 2017 Apr 7:7:46256.
doi: 10.1038/srep46256.

Pectoralis Major Myocutaneous Flap for Head and Neck Defects in the Era of Free Flaps: Harvesting Technique and Indications

Muyuan Liu  1 , Weiwei Liu  2 , Xihong Yang  1 , Haipeng Guo  1 , Hanwei Peng  1
Affiliations

Pectoralis Major Myocutaneous Flap for Head and Neck Defects in the Era of Free Flaps: Harvesting Technique and Indications

Muyuan Liu et al. Sci Rep. .

Abstract

The role of the pectoralis major myocutaneous flap (PMMF) in head and neck reconstruction is challenged recently due to its natural drawbacks and the popularity of free flaps. This study was designed to evaluate the indications and reliability of using a PMMF in the current free flap era based on a single center experience. The PMMF was harvested as a pedicle-skeletonized flap, with its skin paddle caudally and medially to the areola, including the third intercostal perforator, preserving the upper one third of the pectoralis major muscle. The harvested flap was passed via a submuscular tunnel over the clavicle. One hundred eighteen PMMFs were used in 114 patients, of which 76 were high-risk candidates for a free flap; 8 patients underwent total glossectomy, and 30 underwent salvage or emergency reconstruction. Major complications occurred in 4 patients and minor complications developed in 10. Tracheal extubation was possible in all cases, while oral intake was possible in all but 1 case. These techniques used in harvesting a PMMF significantly overcome its natural pitfalls. PMMFs can safely be used in head and neck cancer patients who need salvage reconstruction, who are high risk for free flaps, and who need large volume soft-tissue flaps.

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Conflict of interest statement

The authors declare no competing financial interests.

Figures

Figure 1
Figure 1. A partial circumferential defect of the hypopharynx resulted following ablative surgery for the recurrent hypopharyngeal squamous cell carcinoma after radical chemoradiation. The skin paddle was designed medially to the areola.
Figure 2
Figure 2. The third intercostal perforators from the internal thoracic artery was dissected and transected at its origins.
Figure 3
Figure 3. The pectoral branch of the thoracoacromial artery was identified beneath the pectoralis major.
Figure 4
Figure 4. The pectoralis major muscle was transected at the level of the end of the pectoral branch and the pedicle was skeletonized, leaving its clavicle part and a portion of its sternocostal part intact.
Figure 5
Figure 5. The length of the skeletonized pedicle was 10 cm.
Figure 6
Figure 6. A tunnel was created over the clavicle beneath the pectoralis major muscle where the myocutaneous flap was passed through.
Figure 7
Figure 7. The PMMF was prepared at an appropriate position to repair the hypopharyngeal defect.
Figure 8
Figure 8. Six months after operation, the cosmetic and functional result was acceptable.
See this image and copyright information in PMC

References

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