Clavicular Division Technique: A New Approach for Lengthening the Pectoralis Flap

Abstract

\s=b\Complications associated with using the pectoralis major myocutaneous flap increase significantly when a portion of the paddle is randomized and/or the flap is closed under tension. The clavicular division technique was devised to increase the length of the flap to help alleviate this problem. Thirty pectoralis major muscle flaps were dissected in fresh cadavers, using the clavicular division technique. The length of the flap after transposition was measured and recorded before and after clavicular division. The distance from the sternal notch to the clavicular division point was also recorded. The average gain in length was found to be 2.9 cm, with a range of 0.5 cm to 6.5 cm. The clavicular division technique has been used since in five patients. The increase in length has allowed us to discard some or all of the random portion of the flap. We advocate the use of this procedure on any patient where the surgeon is concerned about the viability of the random portion of the flap and/or when it is felt that the tension on the suture line is excessive.

Osteocutaneous clavicular free flap: A modified approach for compound defects reconstruction

“…For instance, the use of clavicle division has been described to obtain an extension or modified pectoral flap. 7 , 8 Additionally, supraclavicular FFs have also been utilized by authors to reconstruct mandibular defects. 9 However, what sets our approach apart from others are the variations in the soft tissue donor site, clavicle division approach, and flap thickness.…”

Clavicle Survival as a Free Bone Graft: A Case Report of Minor Modification Added to Pectoralis Major Flap

“…Subsequently, after the completion of the flap harvesting procedure, the mid part of the right clavicle was resected to omit the pressure from the bone during the rotation of the full paddle pectoralis major flap. This maneuver also helped to raise the flap more cephalic with minimal tension (6,7). The resected clavicular bone was split and, then, applied as a free bone graft, which was secured to the reconstruction plate by screws (Figure 1B).…”

“…In this article, a full paddle PMMF was applied to cover a large surgical defect in a case with oral squamous cell carcinoma (SCC) spread to the facial structures. The medial portion of clavicular bone was also removed (6,7) and was, then, employed as a free bone graft to reconstruct the mandibular segmental defect. Accordingly, this method can be considered an innovative choice for bone graft in such cases.…”

Pectoralis Major Flap in Composite Lateral Skull Base Defect Reconstruction

“…These techniques have included partially resecting the clavicle as well as tunneling the proximal end of the flap under the clavicle. [17][18][19][20] Despite these alterations, efforts to expand flap reach to the fullest extent have been complicated by pedicle compromise, with resultant partial or total flap loss, a complication that can have significant consequence for the debilitated patient.…”