Myocutaneous muscle flap myocutaneous flap is a composite soft tissue flap in which skin portion provided wound closure while the muscle mass merely served as a carrier for the essential blood supply muscle flap contains only muscle with its blood supply, if required. The pectoralis major myocutaneous flap a versatile flap for. Pectoralis major myocutaneous flap for reconstruction of. The reliability of pectoralis major myocutaneous flap in. The pectoralis major regional myocutaneous flap has found broad application for the reconstruction of head and neck defects. The healthy flap muscle provides adequate protection to the underlying major vessels in the neck. A novel technique to increase the length of tracheal. A modified pectoralis major myocutaneous flap technique. The plane of elevation should include the sternocleidomastoid fascia, as. Pectoralis myocutaneous flap for salvage of necrotic.
Technique for harvesting pectoralis major myocutaneous flap. Ariyan was among the first to use this pedicle flap for head and neck defects 1, 2. Compared with management with pectoralis major turnover flaps or distant pedicled muscle flaps, treatment of these sternal wounds with pectoralis major myocutaneous advancement flaps is simpler and quicker and provides better aesthetic results. The extent of coverage and the reach of the flap are dependent on the anatomy of the patient, modifications of the standard techniques of. Although the pectoralis major myocutaneous flap is often used in head and neck reconstruction, the extension of the skin paddle beyond the inferior limits of the muscle has not been well described. Surgical configurations of the pectoralis major flap for reconstruction. This study compared the outcomes of an extensive segmental pectoralis major myocutaneous flap espmmf and a conventional pectoralis major myocutaneous flap pmmf. It has definite advantages over other myocutaneous flaps used in this region.
Extended pectoralis major myocutaneous flap in head and. Although free flap using microvascular technique is the standard of care, its use is limited by the availability. The pectoralis major flap comprises the pectoralis major muscle, with or without overlying skin, and may include the under lying ribs. A 70yearold man with the diagnosis of poststernotomy osteomyelitis underwent. Evaluation of the pectoralis major flap for reconstructive.
Pectoralis major myocutaneous flap in head and neck reconstruction. The pectoralis major myocutaneous flap a versatile flap for reconstruction in the. The results proved that the flap its continual usage in t3, t4 patients and provides better functional, aesthetic and less donor and recipient site complications. The pectoralis major myocutaneous pmmc flap has been used as a versatile and reliable flap since its first description by ariyan in 1979. Pectoralis major myocutaneous flap for head and neck. Department of oral and maxillofacial surgery, university of tennessee medical center, university of tennessee cancer institute, knoxville, tennessee, usa. Pectoralis major myocutaneous flap pmmc continues to be a prime tool in the armamentarium for the reconstruction of head and neck malignancies even though free flaps have proved their versatility in functional and cosmetic outcomes. The pectoralis major myocutaneous pedicled flap revisited. The pectoralis major myocutaneous flap pmmf is an important reconstructive tool for lesions in the head and neck region. It is the workhorse in centers where the facilities for. The aim of this study was to assess the use of the pmmcf with the prevertebral fascia to close a pharyngeal defect.
Indications and outcomes for pedicled pectoralis major. The pectoralis major flap has been considered the workhorse flap for chest. Pectoralis major myocutaneous flap and myofascial flap iowa. A good reconstruction should not only be functionally and aesthetically sound at the recipient site but also cause least possible cosmetic aberration of the donor site.
Mehrara definition the pectoralis major muscle flap was first reported by pickrell in 19471 and popularized for head and neck reconstruction by ariyanas a myocutaneous flap in 1979. Pectoralis major myocutaneous flap in head and neck surgery. Furthermore, compared with the muscle flap, the myocutaneous flap is superior for its rigidity and the similarity between the skin and internal lining of the trachea. Although free tissue transfer is thought the best option for head and neck reconstruction, the pectoralis major myocutaneous flap pmmcf remains an important alternative method. The pectoralis major myocutaneous flap and myofascial flap variation are utilized in a large variety of head and neck reconstructive procedures that can include coverage of mucosal andor cutaneous defects. The pectoralis major myocutaneous flaps described by ariyan and baek are a hybrid of conleys laterally based deltopectoral flap and huestons inclusion of the pectoralis major muscle in the skin flap. Although freetissue transfer of a vascularized free flap is often preferred, the clinical benefits of the pmmc flap should not be overlooked. The extent of coverage and the reach of the flap are dependent on the anatomy of the patient, modifications of the standard techniques of elevation, and inset. However, techniques in microvascular surgery have since evolved and re cently free tissue transfer has played an important role in head and neck reconstruction. The role of the pectoralis major myocutaneous flap pmmf in head and neck reconstruction is challenged recently due to its natural drawbacks and the popularity of free flaps. The pectoralis major myocutaneous flap in mediastinal. The pedicled pectoralis major myocutaneous pmmc flap is versatile, and is widely used for the treatment of surgical defects following oral.
Pectoralis major myocutaneous flap pocket dentistry. Sternal osteomyelitis with or without mediastinal infection is a severe and rare complication of median sternotomy. The pedicled pectoralis major myocutaneous flap is close to the trachea and sufficient blood supply can be preserved. Pectoralis major myocutaneous flap for head and neck defects in the era of free flaps.
Pectoralis major myocutaneous flap reconstruction in head. Background a 270degree partially tubed pectoralis major myocutaneous flap pmmf is an excellent option for total circumferential pharyngoesophageal defects in patients who are not candidates for more complex reconstructions. Large maxillofacial defects secondary to trauma or cancer ablation frequently pose a challenge for the reconstructive surgeon. The latissimus dorsi myocutaneous flap ldmf is one of the most reliable and versatile flaps used in reconstructive surgery. The pectoralis major myocutaneous flap pmmf is a commonly used flap for reconstructive head and neck surgery. The pectoralis major myocutaneous pmmc flap as a pedicle flap is still a reliable option to reconstruct the defects following major oncological resections of headandneck cancer. Summary pectoralis major myocutaneous flap reconstruction of the defect following surgery for oral cancer in fourteen patients is described. Pectoralis major flap for pharyngeal reconstruction michael a. The very reliable and versatile pedicled pectoralis major muscle pm flap is. This study was designed to evaluate the indications and reliability of using a pmmf in the current free flap era based on a single center experience. Pectoralis major myocutaneous flap in head and neck. The extent of coverage and the reach of the flap are dependent. Pectoralis major flap in composite lateral skull base. When the authors develop what appears to be a new surgical technique, the authors are prone to be excited.
Pectoralis major myocutaneous flap technique for female patients with minimal subcutaneous breast tissue. Brachytherapy afterloading tubes can be inserted and passed underneath the flap. It still holds significance in both primary reconstruction and salvage procedures in head and neck malignancies. Ariyan was among the first to use this pedicle flap for head and neck defects 1,2. Design a local transposition flap can be used to close a large donor defect. The current report describes the indications, design and technique of the extended pectoralis major flap in reconstructing challenging.
The origins of deltopectoral flaps and the pectoralis. Novel technique to increase the pmmc flap pedicle length. Pectoralis major flap vula university of cape town. Pectoralis major myocutaneous flap technique for male patients. A pectoralis major myocutaneous flap is raised and transposed to the neck with the skin island facing outward to replace the unhealthy irradiated skin. The pectoralis major myocutaneous flap is an axial flap which is versatile, reliable and permits reconstructive surgery for head and neck cancer as a primary procedure. This was a retrospective study of 30 patients who underwent circumferential pharyngeal defect. In these patients, an inframammary skin paddle may be used for optimal cosmesis. Pectoralis major myocutaneous flap is a soft tissue reconstructive surgical procedure that provides oral lining and facial cover of soft tissue defects.
A soft tissue reconstructive surgical procedure that provides oral lining and facial cover of soft tissue defects. Although we use free flaps as the first choice for head and neck. Myocutaneous flap an overview sciencedirect topics. Pectoralis major myocutaneous flap for head and neck defects in. Pectoralis major myocutaneous flap and myofascial flap. The pectoralis major myocutaneous flap has enjoyed a long history of over 40 years utilization to reconstruct a variety of head and neck defects. We experienced only one failure of the flap in a patient in whom the right pmf had been previously used in the head and neck area and who underwent ligation of the left innominate vein during the procedure. The pectoralis major flap comprises the pectoralis major.
Exposure of pectoralis major muscle the skin paddle is tacked to the underlying pectoralis major muscle with a few sutures so as to minimise the risk of shearing injury to the myocutaneous per forators the skin and breast tissue above the skin paddle is then widely elevated from the pectoralis major muscle with diathermy up to the clavicle 15. The flap was a sandwich flap that included an overlying parasternal pectoral skin paddle for pharyngeal reconstruction, the pectoralis muscle for carotid protection, and a meshed skin graft applied to the undersurface of the muscle to replace cervical skin. The width and length of the muscle harvested will depend on the size of the defect. An alternative technique for surgical management of. Pectoralis major flap for pharyngeal reconstruction. In this paper, an alternative technique for the reconstruction of sternal defects with the use of bilateral pectoralis major pedicled muscle flaps is presented. The pectoralis major musculocutaneous pmmc flap has been a useful technique for head and neck reconstruction since its first description by ariyan in 1979. The pectoralis major myocutaneous pedicle flap pmmpf has been considered to be the workhorse of pedicled flaps in head and neck reconstruction.
Pmf, including the entire pectoralis major muscle, was routinely used for amt reconstruction. Line a represents the lateral incision, which is the first one made in the procedure. These defects often cannot be closed without excessive tension and obliteration of normal anatomy. We aim to clarify the design and application of this extended flap in head and neck reconstruction.
The pectoralis major myocutaneous flap sciencedirect. The pectoralis major muscle is harvested in full thickness. The pectoralis major myocutaneous flap pmmf is useful in head and neck reconstruction. Ideas and innovations local transposition flap repair of. Pharyngeal reconstruction using a ushaped pectoralis. It provides skin and muscle to cover defects after resection of the temporal bone, in. Comparison of outcomes with extensive segmental pectoralis. Nowadays, free flaps are more common due to improved microsurgical techniques, but in several cases the pmmf still has its advantages, including its proximity to the head and neck. Technique for harvesting pectoralis major myocutaneous flap the surface markings of the vascular pedicle were made by drawing a line from the ipsilateral acromion to the xiphisternum and another line vertically from the midpoint of the clavicle to intersect the first line.
Pdf the pectoralis major myocutaneous pedicled flap. The problems and complications encountered have been found to be minimal. It has an axial blood supply and is based superiorly on the pectoral branch of the thoracoacromial artery. In india head and neck cancer patients usually present in the advanced stage making pmmc flap a viable option for reconstruction. Despite the attractiveness, feasibility and success rates of free tissue transfer, the role of the pectoralis major myocutaneous flap is irreplaceable in. Platysma myocutaneous flap its current role in reconstructive surgery of oral soft tissue defects 5 skin paddle up to the mandible, leaving the platysma down.
The pedicled pectoralis major myocutaneous pmmc flap is versatile, and is widely used for the treatment of surgical defects following oral cancer resection. Improved skin paddle survival in pectoralis major myocutaneous. We report a technique using a local transposition flap to close the pectoralis major donor site. However, techniques in microvascular surgery have since evolved and recently free tissue transfer has played an important role in head and neck reconstruction. The reliability of pectoralis major myocutaneous flap in head and neck reconstruction.
Methods the study enrolled 91 patients with primary oral and oropharyngeal squamous cell carcinoma scc who underwent radical resection followed by reconstruction of the defect. A modified pectoralis major myocutaneous flap technique with. A modified pectoralis major myocutaneous flap was used to stabilize necrotic neck wounds rapidly in irradiated patients. The pectoralis major myocutaneous flap is a major flap for reconstruction of large head and neck defects. Extended pectoralis major myocutaneous flap in head and neck. The pectoralis major myocutaneous flap pocket dentistry. Sternal dehiscence after open heart surgery and reconstruction with pectoralis flap. The pectoralis major myocutaneous pedicle flap pmmf is still being used by many surgeons and plays an important role in head and neck reconstruction. The pectoralis major myocutaneous pmmc flap continues to be one of the most commonly used flap for head and neck reconstruction in this part of the world.
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