Indications for pedicled pectoralis major flap in a free tissue transfer practice

Abstract

The pedicled pectoralis major myocutaneous flap (PMMF) was highly used over the last 3 decades. The current era of free tissue transfer has gradually relegated the PMMF to a secondary role. In a retrospective review of all patients undergoing pedicled PMMF from 2002 to now, we sought to determine the current role and assess the outcomes of the PMMF in a primary microvascular head and neck reconstructive center. Fifty-five PMMFs were performed in 53 patients (24 myocutaneous and 31 myofascial); group 1 consisted of 20 patients (38%) who underwent a secondary PMMF after a free flap complication (flap failure 9/20, fistula 5/20, wound breakdown with great vessel exposure 3/20, loss of soft tissue skin paddle 2/20, and delayed hematoma in 1/20); group 2 included 18 patients (33%) who had a simultaneous free flap with a PMMF for dead space filler or cervical skin/great vessel coverage reconstruction, whereas the remaining 15 patients (29%) in group 3 underwent primary PMMF for reconstruction of cervical skin defect, great vessel coverage, pharyngocutaneous fistula, infection, and dead space filler. Complications of PMMF included 3 hematomas, 2 partial dehiscences, 1 chest wall abscess, and 1 case of mastitis. Because of cervical tethering, 14 of 53 patients underwent secondary pectoralis myectomy with cervical contracture release at a mean of 10.3 months after initial surgery. The pedicled PMMF continues to serve an important role in head and neck reconstruction in the microvascular era with notable uses for free flap rescue, with simultaneous free flap reconstruction and for primary reconstruction in select circumstances with an overall acceptable short- and long-term morbidity profile.