Extending the Arc of Rotation of the Pectoralis Major Myocutaneous Flap for Orofacial Reconstruction via a Modified Subclavicular Route Through the Clavipectoral Fascia

Comparison of outcomes with extensive segmental pectoralis major myocutaneous flap via the anterior axillary line and the conventional technique in oral and oropharyngeal cancer

“…The esPMMF may be used to reconstruct craniomaxillary defects. Extending the arc of rotation of the PMMF enabled the reconstruction of defects up to and above the level of the oral commissure; an externalized pedicle allows the PMMF to reach the periorbital area and anterior skull base, but the pedicle needs to be protected and wrapped 2‐3 weeks after flap division . We believed that the range was extended by designing the skin paddle inferior to the areola to the seventh intercostal space; and the flap is transferred under the clavicle, which permits safe, easy passage of the flap while giving it a large arc of rotation and achieving an increased pedicle length and decreased pedicle bulk.…”

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

“…Eugene et al conducted a retrospective cohort study to compare the gain in extension that could be achieved with modified subclavicular tunnel versus supraclavicular overlay, and concluded that there was achieving an again in extension of 3.2 cm with modified subclavicular. 18 Chen et al conducted a prospective study to compare the outcomes of an extensive segmental PMMF (esPMMF) and a conventional PMMF. The pedicle lengths of the esPMMF were longer than those of the conventional PMMF.…”

“…One of the most adopted modifications is the passage of the PMMF to the head and neck area through a subclavicular route. Eugene et al conducted a retrospective cohort study to compare the gain in extension that could be achieved with modified subclavicular tunnel versus supraclavicular overlay, and concluded that there was achieving an again in extension of 3.2 cm with modified subclavicular 18 . Chen et al conducted a prospective study to compare the outcomes of an extensive segmental PMMF (esPMMF) and a conventional PMMF.…”

“…The PMMF still has an important role in the free flaps ear; unfortunately, it is reported to have drawbacks such as the limited cephalad extension and high incidence of total or partial flap necrosis. Several reports have highlighted the need to address the limited cephalad extension of the PMMF and the unstable blood circulation of the skin paddle 4,13–20 . In anatomical research and clinical trials concerning the PMMF, the contribution of the lateral thoracic artery (LTA) has received considerable attention (Figs.…”

“…Several reports have highlighted the need to address the limited cephalad extension of the PMMF and the unstable blood circulation of the skin paddle. 4,[13][14][15][16][17][18][19][20] In anatomical research and clinical trials concerning the PMMF, the contribution of the lateral thoracic artery (LTA) has received considerable attention (Figs. 1 and 2).…”