Pectoralis Major Myocutaneous Flap—Still a Workhorse for Maxillofacial Reconstruction in Developing Countries

Case Reports of Two Unusual Donor Site Complications of the Pectoralis Major Myocutaneous Flap and Literature Review

“…The main reason has been the greater rate of complications associated with the PMMF compared with that of the MFTF, 16,17 resulting in longer hospital stays 3 and greater financial burden. [5][6][7]18 However, it is still useful as a salvage flap in the case of free-flap failures 4,5,8,17 and might be the best option when using the MFTF is not possible (eg, medical comorbidities, hypercoagulable states, lack of recipient vessels, and limited resources or microsurgical specialists in developing countries). 4,7,10,19 Moreover, the large bulk of intervening muscle is useful for covering the great vessels in the neck in the case of radical neck dissection 7,9,14 and for preventing pharyngocutaneous fistula in case of laryngopharyngectomies.…”

“…The donor site complication rates have ranged from 0 to 71.4% (Table 1). 4,5,9,11,14,15,17,20,[22][23][24][25] This wide range has resulted from the variability of the definition of complications in published studies. For example, the severity and occurrence of shoulder dysfunction have not been quantitatively well studied, and the degree at which different investigators have defined has varied widely in published studies.…”

“…Complete hemostasis is also mandatory to prevent hemothorax formation, because the vessels can retract into the intercostal muscles. 4 The drains should be removed when the drainage is serosanguinous and less than 25 to 30 mL/day. A murky, foamy fluid should be cultured and tested for amylase to rule out the presence of a salivary fistula.…”

“…This is particularly important in the case of PMMF failure, for which the deltopectoral flap might be necessary as a salvage flap. 4,12,19,23,29 It is not recommended to preserve the skin perforators from the lateral thoracic artery, because the lateral thoracic artery is the main blood supply to the pectoralis major muscle in some patients and should be included in the PMMF to ensure its viability. 36 Although the inclusion of the lateral thoracic artery gives the flap a broader base and bulkier flap when crossing the clavicle, it supercharges the PMMF by connecting directly to the other branches supplying the muscle 39,40 and provides almost 100% reliability for the PMMF.…”

Preservation of Aesthetics of Breast in Pectoralis Major Myocutaneous Flap Donor Site in Females

“…It has the advantage of constant vascular anatomy, adequate reach to oro-pharyngeal defects, technical ease, less time consuming, and provides muscle cover to exposed major vessels in neck after neck dissection [1,2]. It still holds the position of ''work-horse'' in head and neck reconstruction in developing countries and in selected complicated cases [3][4][5].…”