Abstract
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. 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. The PMMF was harvested as a pedicle-skeletonized flap, with its skin paddle caudally and medially to the areola, including the third intercostal perforator, preserving the upper one third of the pectoralis major muscle. The harvested flap was passed via a submuscular tunnel over the clavicle. One hundred eighteen PMMFs were used in 114 patients, of which 76 were high-risk candidates for a free flap; 8 patients underwent total glossectomy, and 30 underwent salvage or emergency reconstruction. Major complications occurred in 4 patients and minor complications developed in 10. Tracheal extubation was possible in all cases, while oral intake was possible in all but 1 case. These techniques used in harvesting a PMMF significantly overcome its natural pitfalls. PMMFs can safely be used in head and neck cancer patients who need salvage reconstruction, who are high risk for free flaps, and who need large volume soft-tissue flaps.
Highlights
Since its introduction by Ariyan in 1979, the pectoralis major myocutaneous flap (PMMF) has been used as a workhorse flap for the reconstruction of the head and neck defects in the following three decades[1,2,3,4,5]
When there were multiple factors leading to the use of a PMMF, the principle one identified for the choice was listed as the indication
We harvested the PMMF using the following techniques: the skin paddle is designed caudally-medially to the areola; the third intercostal perforating branch of the internal thoracic artery is included in the flap; the clavicle portion and part of the sternal portion of the pectoralis major is left intact; and the flap is sent to the recipient site via the sub-muscular tunnel over the clavicle and beneath the platysma flap after the clavipectoral fascia is divided
Summary
Since its introduction by Ariyan in 1979, the pectoralis major myocutaneous flap (PMMF) has been used as a workhorse flap for the reconstruction of the head and neck defects in the following three decades[1,2,3,4,5] Advantages of this flap include its easy harvest, abundant soft tissue volume, large skin paddle, relative versatility, considerable reliability, and short operating time. The PMMF is popularized in developing countries with limited medical resources[5,11,12], whereas it is used much less in Western countries where availability of microsurgical techniques is more widespread[3,13,14] It seems that the role of the PMMF in head and neck reconstruction has shifted from a “workhorse flap” to a “salvage flap” in the era of free flaps[9]. In the current cohort study, we report our experience of using 118 PMMFs in 114 patients by a single surgical team, focusing on flap harvesting techniques, indications, and surgical outcomes
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