Pectoralis Major Musculocutaneous Flap Research Articles

The use of the pectoralis major musculocutaneous flap in the cervicomaxillofacial surgery of irradiated patients : Wilk A, Balme P, Keiling R, et al. Ann Chir Plast Esthet, 30:373–378, 1985

The use of the pectoralis major musculocutaneous flap in the cervicomaxillofacial surgery of irradiated patients : Wilk A, Balme P, Keiling R, et al. Ann Chir Plast Esthet, 30:373–378, 1985

Pectoralis major musculocutaneous flaps: long-term follow-up of hypopharyngeal reconstruction.

We have reviewed our experience with 25 patients who have undergone major head and neck resections and required hypopharyngeal pectoralis major flap reconstruction. Six patients were alive 1 year following reconstruction and five patients consented to evaluation of flap function with endoscopy, with biopsy, barium swallow, and esophageal manometrics. The patients were older (61 +/- 6 years) and the flaps were large (42 +/- 9 cm2). Barium studies were the most useful method of evaluating these patients. Postoperative stricture and laryngeal aspiration were found in two patients. Biopsy of the flap demonstrated loss of keratin in the overlying epidermis, while the gross appearance was more like the surrounding mucosa. A review of dietary intake in these cases revealed that two patients weighed less than their preoperative weights, while another refused oral feedings despite a good functional result. Three of five patients preferred gastrostomy feedings to oral alimentation.

The clavicular head of pectoralis major musculocutaneous free flap

A new free flap is described based on the deltoid vessels of the acromiothoracic axis. The flap is comprised of the clavicular head of pectoralis major muscle with overlying skin. It is also possible to harvest vascularised clavicular bone with the flap. The vascular anatomy is reviewed and the technique of raising the flap described. Its clinical application is illustrated with five cases. Four of these were intra-oral reconstructions and the fifth a composite osteo-musculocutaneous flap to a lower limb following trauma.

Total reconstruction of the hypopharynx and cervical esophagus.

Patients with extensive circumferential tumors of the hypopharynx and those with carcinomas of the cervical esophagus usually require resection of a cylindrical segment of the upper digestive tube. These patients present similar difficulties of reconstruction and also share a very poor prognosis. At times, the same complicated technical effort is required for palliation and definitive cure alike. From 1970 through 1982 at the University of Texas-M.D. Anderson Hospital at Houston, 78 patients underwent complete resection of the hypopharynx (54 patients) or the cervical esophagus (24 patients) for advanced malignant tumors. Seventy-three tumors were squamous cell carcinomas, and the remaining 5 were cancers that originated in the salivary gland. These large tumors were not staged according to the TNM system, since they frequently involved two different anatomic structures and a precise clinical assessment was not always possible. The only criterion for inclusion of patients in this series was the need to replace the entire pharynx or cervical esophagus after removal of the cancer. Of the 78 patients, 64 received their entire treatment at our institution, and of this group, 44 patients had only one surgical procedure. All patients in the series had circumferential resection as the final surgical step at our institution. The types of repair used in this group of patients were a cutaneous flap or graft in 44 patients, a colon bypass in 16 patients, a lateral trapezius musculocutaneous flap in 9 patients, and a pectoralis major musculocutaneous flap in 6 patients. In three additional patients, the reconstruction was initially delayed for various reasons and was ultimately abandoned. Technical considerations and a detailed analysis of the complications and palliative value of each procedure are presented. The merit of these procedures is judged according to the quality and the length of the patient's survival. Although the degree of palliation varies considerably according to the technique used, the survival rates were similar in all cases, the average being 43 percent at 5 years after the first treatment attempt and 27 percent at 5 years after the surgical resection that required a complete circumferential reconstruction.

Complex Thoracic Wounds: Muscle and Musculocutaneous Anatomy in Closure

Closure of the infected sternotomy has been facilitated by the use of the pectoralis major musculocutaneous flap and has been well described. This paper describes six cases of more complex infected thoracotomies and the methods of closure. Knowledge of the dual blood supply of many of the thoracic musculocutaneous units is important in closure of these difficult thoracic wounds. The axial and segmental blood supply of the large flat muscles of the chest wall can be exploited to satisfy complex defects involving both vertical and transverse thoracotomy incisions and therefore decrease the risk of progressive infection and erosion of major vascular structures.

Reconstruction after mediastinal tracheostomy

Mediastinal tracheostomy has been associated with high morbidity and mortality, often due to skin necrosis, with resultant exposure of the great vessels and subsequent hemorrhage. During a 4 year period, 11 patients underwent mediastinal tracheostomy. Reconstruction included the use of a pectoralis major musculocutaneous flap to provide well-vascularized skin for anastomosis to the superior portion of the tracheostoma in nine patients. Whenever possible (eight patients), the trachea was transposed below the innominate artery to allow for slightly more mobility of the trachea and to remove the cartilaginous portion of the trachea from the artery. Among the eight elective operations reported herein, there were no postoperative deaths and only two minor wound-related complications. Among three patients who underwent emergency mediastinal tracheostomy, two patients died, one with an aneurysm of the innominate artery that ruptured several weeks postoperatively and the other with respiratory instability who could not be weaned from the respirator. These results suggest that use of the pectoralis major musculocutaneous flap and tracheal transposition decreases the risk of skin necrosis and resultant major vessel rupture. We advocate this approach in the reconstruction of the patient who requires mediastinal tracheostomy.

Reconstruction of the hypopharynx following extensive loss of mucosa

Mucosal loss of the hypopharynx, following pharyngostome or wide resection of carcinoma, poses problems for repair. The authors emphasize a reconstructive procedure based on the use of three elements combined together in various ways: residual strip of mucosa of the posterior pharyngeal wall, a musculomucosal pedicled flap obtained from the base of the tongue, a pectoralis major musculocutaneous flap. Thus any defect of the hypopharynx can be repaired in one stage. The safety of the procedure is well tested with good clinical results and lack of complications.

Orbital exenteration and reconstruction for massive basal cell and squamous cell carcinoma of cutaneous origin.

Eleven patients with basal cell or squamous cell carcinomas of skin origin requiring orbital exenteration over a ten-year period were reviewed. The patient population was characterized by old age, treatment delay, massive tumor size, and inadequate primary therapy. Following orbital exenteration, a 60% recurrence rate and 56% five-year survival were found. Combined craniofacial resection should be considered more frequently in hopes of improving prognosis. Split-thickness skin grafting was the mainstay of reconstruction, especially in elderly patients with smaller lesions. However, most of the operations were performed prior to the popularization of musculocutaneous flaps and free tissue transfers. Temporalis, forehead, and cheek flaps are dependable local alternatives when additional bulk or improved contour is desired. Latissimus dorsi and pectoralis major musculocutaneous flaps and microsurgical tissue transfer allow for coverage of defects of virtually unlimited size and may be superior in cases in which infectious or postradiation complications are anticipated.

Pharynx, Larynx, Trachea, and Esophagus: Primary reconstruction of the cervical esophagus with a pectoralis major musculocutaneous island flap. (Japanese)

Pharynx, Larynx, Trachea, and Esophagus: Primary reconstruction of the cervical esophagus with a pectoralis major musculocutaneous island flap. (Japanese)

Major chest wall reconstruction after chest wall irradiation

In the last year, 12 patients have undergone extensive chest wall resection. Eight patients had recurrent cancer after prior resection and irradiation with an average defect of 160 square centimeters, usually including ribs and a portion of the sternum; four had radionecrosis of soft tissue and/or bone. Methods of reconstruction included latissimus dorsi musculocutaneous (MC) flap (five patients), pectoralis major MC flap (seven patients), and omental flap and skin graft (one patient). The donor site was usually closed primarily. All flaps survived providing good wound coverage. The only complication was partial loss of a latissimus dorsi MC flap related to an infected wound; this reconstruction was salvaged with a pectoralis major MC flap. The hospital stay ranged from 10-25 days with a median stay of 11 days. Use of the MC flap is a valuable tool which can be used to significantly decrease morbidity, hospital stay, and patient discomfort related to the difficult problem of chest wall reconstruction after radiation therapy.

One-Stage Cervical Esophageal and Pharyngeal Reconstruction for a Fourth Primary Cancer

This case is presented to describe how an ellipse of skin taken with a pectoralis major musculocutaneous flap can be sewn in a spiral fashion to make a water-tight tube to replace the cervical esophagus. While this case may represent a technical triumph of the use of musculocutaneous flaps, we cannot help but feel it is a hollow victory because of the patient's addiction to cigarettes and alcohol. While constant attention and hard work have kept her alive for 16 years, with four primary cancers of the oral cavity, pharynx, and proximal esophagus, continued use of alcohol and cigarettes (Fig. 7) may well defeat our technical advances.

Pectoralis major musculocutaneous flap: A new flap in head and neck reconstruction

The pectoralis major musculocutaneous flap described by Ariyan has great potential in single stage reconstructions of the head and neck. The advantages of the flap are greater length, improved vascularity, bulk, and one-stage reconstruction of oropharyngeal defects. The flap was used successfully in eight patients to reconstruct large defects in the head and neck area. Experience to date indicates that this flap has greater versatility than the deltopectoral flap in one-stage head and neck reconstructions.

Pectoralis Major Musculocutaneous Flap and Splitthickness Skin Graft for The Reconstruction of Pharyngocutaneous Fistula After Total Laryngeal Resection

Background: Pharyngocutaneous fistula (PCF) is the most frequent complication in the early postoperative period after total laryngectomy. Most PCF respond well to conservative management, but when it fails and the fistula persists surgical closure in indicated. Patients and Methods: Sixty-five year-old male was consulted to our division following total laryngectomy by the Ear Nose Throat surgeons, with wound dehiscence and pharyngocutaneous fistula. We performed a pectoralis major musculocutaneous flap (PMMCF) to close the fistula after a failed conservative management. The skin island of PMMCF was used as an inner lining to close the laryngeal fistula, the exteriorized muscle part of the "ap was then covered by skin graft.Results: PMMCF is a technically simple and reliable distant musculocutaneous pedicled flap to cover defect on the neck area. The skin island of the flap provided an adequate air-thight cover and successfully closed the laryngeal fistula.Summary: PCF is a problematic complication resulting from the resection of head and neck tumor. Early diagnosis and proper multidisciplinary management is required to prevent further morbidity. PMMCF is a simple, easy to perform and reliable option for closure of PCF.