A Modified Design of the Pectoralis Major Myocutaneous Flap for Reconstruction of Head and Neck Defect

Abstract

Even though the pectoralis major myocutaneous flap (PMMF) still has an important role in the free flaps ear, it is reported to have drawbacks such as the limited cephalad extension and high incidence of total or partial flap necrosis. Various modifications have been attempted to augment the limited cephalad extension and a stable blood supply.The aim of this study is to describe a modified design of the skin paddle and preparation of the PMMF, to achieve stable blood circulation and sufficient pedicle length. The priority skin paddle is the medial part for its stable blood supply, and the lateral margin should be adjusted as needed. During the harvesting, the lateral thoracic artery (LTA) is preserved to protect the perforating branches, and the anterior sheath of the rectus abdominis muscle is used as a suture margin to prevent damage of the thin muscle of the PMMF. The skin paddles in this study are larger than those previously reported. All of the 21 patients in our study, the skin paddles show complete survival with no partial necrosis of skin paddle, fistula, or wound dehiscence.It is worthwhile to consider and preserve the LTA as a major contributor to a lateral and distal PMMF. This study would be useful in future and preparation of the PMMF in head and neck reconstruction.

Use of the pedicle of previously harvested pectoral myocutaneous flap as a recipient for free flaps in head and neck reconstruction

“…The PMF has been used for head and neck defects for many years and the advantages and disadvantages are well known in the literature (Aycock et al, 2008; Kiyokawa et al, 1998; Lyu et al, 2021; Oh et al, 2018; Squaquara et al, 2010; You et al, 2012). So, considering the importance of PMF as a workhorse lifeboat regional flap option, flap loss and/or complications may be catastrophic especially for difficult head and neck reconstructions.…”

“…However, naturally, some complications such as partial or total necrosis of the skin island or wound healing problems may occur (Shah et al, 1990) and the final defects may require free flaps for the best reconstructive results. While there are many studies about the use, advantages, complication rates and modifications of PMF, the number of detailed studies focusing on what should be done against failure of this life‐boat flap is insufficient (Lyu et al, 2021; Makiguchi et al, 2013; Ossoff et al, 1983; Shah et al, 1990; Squaquara et al, 2010; Tang et al, 2012). In this scenario, instead of discarding or totally sacrificing the complicated PMF, they may still be used as a beneficial server for free flaps.…”

T-Inverted Shaped Rectus Abdominis Myocutaneous (Ti-Ram) Flap for Chest Wall Reconstruction

“…Furthermore, due to the position of the recipient site, it may not fully reach and completely cover the loss of substance [24][25] . Pectoralis major muscle flap represents a further pedicled flap alternative, indifferently used as an advancement or rotation flap based on the internal mammary artery perforators [26][27][28][29] . As reported by Bakri et al, although it is ideally suited to central chest defects, low sternal and xiphoid defects may be out of reach for the pectoralis flap 30 .…”