A Method that Preserves Circulation during Preparation of the Pectoralis Major Myocutaneous Flap in Head and Neck Reconstruction

Abstract

The present article describes a method that preserves circulation during the preparation of the pectoralis major myocutaneous flap used in head and neck reconstruction. The major disadvantage of this flap is its poor circulation and consequent partial necrosis. To solve this problem, we analyzed the circulation and hemodynamics of the pectoralis major myocutaneous flap (the perforator of the anterior intercostal branch located about 1 to 2 cm medial to the areola in the fourth intercostal space is important), evaluated the safe donor sites in the chest wall for a skin island (the perforator is included on the skin island's central axis), improved the surgical procedure for elevating flaps (for preventing perforator injuries), and devised a means to transfer flaps, thereby increasing the range of the flaps (the transfer route is under the clavicle). Using this technique, head and neck reconstruction was performed on 62 patients. The diagnosis included oral cancer (21), oropharyngeal carcinoma (10), parotid carcinoma (10), hypopharyngeal carcinoma (9), and other head and neck malignant tumors (12). Of these, partial or marginal necrosis of the flap caused by circulatory problems was detected in three patients (5 percent). Using our method, the problems associated with inadequate circulation in the pectoralis major myocutaneous flap were greatly alleviated, thus reconfirming the usefulness of this flap in head and neck reconstruction.

The Breast Musculocutaneous Flap for Complete Coverage of the Median Sternotomy Wound

“…7,12,15,18 This may be due to further devascularization of already ischemic tissues that must then rely solely on the lateral thoracic or anterior intercostal perforators for collateral circulation. 19,20 Other adjunctive techniques for sternal wound closure that do not violate the chest wall or increase the risk of breast ischemia include the use of the rectus abdominis muscle alone 14,16 or omentum. 2,9,10 Both these flaps have known inherent risks even for those with an average body habitus, 2,9,12 and their harvest often is a formidable feat in this extremely obese subset of patients.…”

Refinement of Operative Method for Single-Stage Treatment of Pectus Excavatum and Heart Disease

“…Surgical techniques for pectus excavatum are largely classified into sternum turnover 5 or sternum elevation. 3,6,7 With regard to turnover techniques, Scheer 8 used the rectus abdominis muscle as the pedicle, and Hirayama et al 9 performed vascular anastomosis of the right and left internal thoracic artery and vein. With regard to elevation techniques, Hoshi et al 5 modified Ravitch's technique and elevated the sternum together with the left internal thoracic artery and vein.…”

Pectoralis Major Musculocutaneous Flap With Nipple-Areola Complex in Head and Neck Reconstruction

“…[3][4][5][6][7][8][9][10][11][12][13] Kiyokawa et al 12 reported 10% partial or marginal necrosis of the cutaneous paddle and total PMMF necrosis in 1% of 151 patients. Castelli et al 13 have reported that the most frequently encountered complication of PMMF is skin island necrosis (5 partial and 1 total) on 84 consecutive patients.…”

“…Skin island necrosis was reported to occur in between 7% and 27% of the flaps. [3][4][5][6][7][8][9][10][11][12][13] Rich blood supply of the nipple-areola complex led us place this unit on the skin island to capture the maximum amount of blood to perfuse the skin paddle. A recent anatomic study by Rikimaru et al 14 on fresh cadavers has suggested that the skin island might include the areola and nipple complex for stabilizing the blood circulation of the skin paddle of the PMMF, which may be grafted back to the original position as a composite graft to achieve better functional and/or esthetic results.…”