The Pectoralis Major Flap Anchor Design: A Novel Modification

The pectoralis major flap was originally reported in 1947 and was able to transform head and neck reconstructive surgery by providing a source of vascularized tissue with the result of decreasing the overall complication rate and improving functional outcomes. Patients who undergo pectoralis major myocutaneous flap reconstruction experience higher complication rates and longer durations of hospitalization than those who undergo revascularized free tissue transfer. The higher associated complication rate results from the increased incidence of flap necrosis that further results in wound abscess and fistula. In this case presentation, we describe a novel modification of the pectoralis major myocutaneous flap in which a vertical release is performed on the neck tunnel. The release and its defect is then added to the pectoralis cutaneous outline. A major benefit of this modification is the resultant decreased pressure on the vascular pedicle. The benefit of this modification is it also provides additional soft tissue coverage of the major vessels of the neck, particularly in the postirradiatedneck, in which fibrosis, atrophy, and scarring can cause a significant soft tissue deficit.

References:

1. Chepeha D et al: Pectoralis major myocutaneous flap vs revascularized free tissue transfer. Arch Otolaryngol Head NeckSurg 130: 181-186, 2004

2. Carlson E: Pectoralis major myocutaneous flap. Oral Maxillofacial Surg Clin N Am 15: 565-575, 2003