Techniques for island design of pectoralis major muscle flap and risk control

Abstract

The pectoralis major muscle flap has been clinically used for more than 40 years. When harvesting the traditional pectoralis major muscle flaps, it is necessary to cut the upper half of the pectoralis major muscle, and use the thoracoacromial vessels and its surrounding pectoralis major muscle as the pedicle, resulting in the loss of the function of the pectoralis major muscle. Hypertrophic pedicle also squeezes the responsible vessels and prevents the flap from being transferred to recipient area, often leading to the partial necrosis of the flap end. The author proposes an improved method to harvesting pectoralis major muscle island flap, and summarizes it as a "ten-step procedures". The key point is to identify the "lowest penetrating muscle point"（LPMP） during the operation, and points out that it is safe to cut off the muscle pedicle 2cm above LPMP. The pectoralis major muscle island flaps not only preserves the function of the donor site's pectoralis major muscle to the utmost extent, better restores the swallowing and vocal function of the recipient site, but also improves the safety of flap harvesting, which will be benefit to patients.