Pectoralis Major Myocutaneous Island Flap Research Articles

Efficacy of the treatment of pharyngeal fistula through pectoralis major myocutaneous flap combined with fistula local skin inversion in 20 cases

To sum up the efficacy of treatment of pharyngeal fistula through pectoralis major myocutaneous flap combined with fistula local skin inversion in 20 patients. A retrospective analysis of the therapeutic efficacy in 20 cases of laryngeal and laryngopharyngeal cancer with postoperative pharyngeal fistula, to whom double-deck repairing were operated on through pectoralis major myocutaneous island flap combined with inversion of skin around fistula from January 2010 to December 2013. 20 patients were treated by improved pharyngeal fistula inverting suture of pectoralis major myocutaneous flap combined with the skin around the pharyngeal fistula. Flap around the fistula were sutured without tension formation. The pectoralis major myocutaneous flaps were sutured without tension formation covering the inner flanging flap wound. 20 patients were on a nasogastric liquid diet after operation for one week and received antibiotics to prevent infection. Then they all took liquid diet after one week, and had extubation safely later. Stitches were removed 10 more days later. All the twenty patients were recovered successfully, among them, 16 cases recovered in stage Ⅰ and left the hospital 10 days later, 4 cases recovered in stage Ⅱ and left the hospital 20 days later. All the 4 cases recovered in stage Ⅱ were treated with radiotherapy. Fistulas less than 1 cm occurred near their anastomotic stomas at 7 to 14 days after operation. They were healed well by dressing change and pressure dressing. No recurrence was observed during the six months follow-up. Pectoralis major myocutaneous flap combined with fistula local skin inversion is a good way to repair pharyngeal fistula, and it is suitable for the laryngeal and laryngopharynx cancer patients with postoperative throat fistula in an internal diameter larger than 2 cm.

Pectoralis major myocutaneous island flap for reconstruction of head and neck defects

Background: Pectoralis major myocutaneous island flap for reconstruction has been used since many decades with success. There is need to evaluate the efficacy of pectoralis major myocutaneous island flap for reconstruction in head and neck surgeries. The objective of the study was to study reliability and usefulness of pectoralis major myocutaneous flap. Methods: This study was carried out for a period of two years at T. N. M. College and Nair Hospital, Mumbai. During this period 12 cases were treated and evaluated. Institutional ethics committee permission was taken. Individual patient consent was obtained. History and clinical examination was carried out as per the protocol. In all cases routine investigations as well as additional investigations as per the case were done. Pectoralis major myocutaneous island flap (PMMC) was used for primary and secondary procedures. Results: Age of patients ranged from 36-70 years. Majority of patients were between 51-70 years of age. In this study, males outnumbered females. The male to female ratio was 2:1. In the majority of cases, single paddle pectoralis major myocutaneous flap was used, whereas double paddle was used in only 2 cases. Donor site was sutured primarily in 8 cases. Split thickness skin grafting was done in 4 cases for donor site of D. P. flap. Superficial necrosis of skin Island was seen in one case. 50% of the patients did not have any complications. In five cases of cheek defect reconstruction, mouth opening was 2 finger breadths. There was no difficulty for swallowing of solids and liquids in 4 cases of pharyngocutaneous fistulae. Conclusions: Pectoralis major myocutaneous island flap for reconstruction of head and neck defects was found to be very effective. Post-operative complications were rare.

Infraareolar pectoralis major myocutaneous island flap as treatment of first choice for deep sternal wound infection

Deep sternal wound infection (DSWI) is a grave complication of median sternotomy, associated with high morbidity, mortality and escalating treatment costs. There is general consensus that optimal treatment comprises radical debridement followed by coverage with a vascularised flap. However, there is ongoing debate regarding the ideal operative procedure. We present our experience with the infraareolar pectoralis major island myocutaneous flap (PEC-MI flap) as treatment of first choice in DSWI. Following a retrospective chart review, data pertaining to patient demographics, type of cardiac surgery performed, prevalence of known DSWI risk factors, identified pathogens, duration of surgery, flap-related complications, duration of hospital stay and antibiotic therapy, as well as mortality were noted. Additionally, we describe the operative technique and review the relevant literature. Twenty-five patients underwent coverage with the PEC-MI flap in our department. The average age was 69.2 years. Nineteen patients underwent coronary artery bypass surgery, 10 valve replacement, two aortic replacement surgery and one pericardiectomy. In six cases, no internal mammary artery was used in cardiac surgery, in 11 cases one and in seven cases both internal mammary arteries were used. The average duration of surgery was 154.2min and the average hospital stay was 28.4 days. Complications which required revision surgery were haematoma in three cases, one wound dehiscence and one recurrent infection. Two cases required coverage with an additional regional flap. The PEC-MI flap has been used as flap of first choice in our clinic for treatment of DSWI. It is sufficient to raise the flap unilaterally, and it does not require skin grafting. The combination of immunocompetent bulky muscle tissue used to obliterate the sternal cavity and the large skin paddle enabling a low-tension skin closure allows reliable and efficient treatment of this severe complication.

Experience of the pectoralis major myocutaneous island flap in simultaneous reconstruction of defects after the resection of oral carcinoma

Experience of the pectoralis major myocutaneous island flap in simultaneous reconstruction of defects after the resection of oral carcinoma

Application of modified pectoralis major myocutaneous island flap in head and neck surgeries

To preserve the function of the donor site and good cervical shape, a modified pectoralis major myocutaneous island flap was designed. The modified pectoralis major myocutaneous flaps were used to repair primarily the defect in head and neck surgery. In all 17 cases, six cases were patients with recurrence of larynx or hypopharynx cancer, four cases with hypopharynx cancer, three cases with base of tongue cancer, two cases with recurrence of maxillary cancer, one case with tonsillar cancer and one case with pharyngeal fistula after hypopharyngeal cancer surgery. Before operation, ultrasound was used to mark the projection of the pectoral branches of thoracoacromial artery, and the pectoralis major myocutaneous were designed according to the axle between lowest entering muscle point of the artery and the fourth intercostals perforator spot of mammary artery; the incision was designed to turn laterally in an oriental direction at the top of the flap and upward along the anterior axillary line; the internal pectoral nerve was reserved, as well as the partial lateral pectoral nerve. The flaps were transferred to recipient site either above or below the clavicle on the premise of the integrity of clavicular part. The distance of the lowest entering muscle point of pectoral branche measuring during operation, which was all in sternocostal part, to the midpoint of inferior clavicula margin was (4.9 +/- 1.2) cm (average +/- s), and in 76.5% (13/17) of the patients, the location was coincidence by ultrasound. The length between entering muscle point and the fourth intercostals perforator spot of mammary artery was (1.8 +/- 0.5) cm. All the myocutaneous flaps were alive except one case. The flap was given up as a result of the vessel pedicle injure. The distal end of the flap was dehisced from the residual tongue in one case with base of tongue cancer and healed with changing dressing. Two pharyngeal fistulas in another two cases were healed with conserved treatment. The rate of the flap survival was 94.1% (16/17). Functions as adduction and adtorsion of major pectoral muscle were integrated within 4 weeks to 3 months. Also, the good looking of the neck and upper chest was maintained. The location of pectoral branches of thoracoacromial artery and the site of the lowest entering muscle point marked by ultrasound detection could help the design of the flap. The modified pectoral' s major myocutaneous flap designing presented better functional protection and reach longer distance and left a better looking for neck and upper chest.

大胸筋皮弁の生着因子に関する検討

In the present study, we analysed patient characteristics and other factors related to flap viability in 19 patients who underwent reconstructive surgery using a pectoralis major myocutaneous island flap in our department over 6+ the past eight years. In these 19 patients (15 males and 4 females), the flap was used on the luminal side of the oral cavity and oropharynx after radical surgery for the treatment of carcinoma of the tongue (10 cases), carcinomas of the oral floor and gingiva (5 cases), and oropharyngeal carcinoma (1 case). Wound complications in the island flap or cervical skin incision site occurred in 11 out of 19 patients, and included partial necrosis of the island flaps (8 cases), dehiscence of the cervical skin incision site (7 cases), dehiscence of the island flap margin (3 cases) and so on. All four of the patients with diabetes mellitus had some wound complications. A comparison of blood data a month before surgery patients with and without wound complications, revealed the mean value of total protein to be significantly lower in the group with wound complications than that in the group without wound complications. A comparison of blood data one month after surgery revealed a significantly higher leukocyte count in the group with wound complications than in the group without wound complications. When a comparison of the incidence of wound complications was made between the group with radiation therapy and that without radiation therapy, the former group showed a higher incidence of complications in the cervical skin incision site than the latter group did, in cases of cervical irradiation.

Sensibility and cutaneous reinnervation of pectoralis major myocutaneous island flaps: A preliminary clinical report

The cutaneous sensibility of 13 pectoralis major cutaneous island flaps has been investigated retrospectively. Although in raising the pectoralis major myocutaneous island flap sensory denervation of the skin is produced, after a mean follow-up period of 29 months (range 5 to 71 months), 68% of the cutaneous portion of the flap revealed sensibility to touch, suggesting a reinnervation from the surrounding intact oral mucosa or skin. The rate of reinnervation was found to be related to the sensibility present in the surrounding tissue.

Microvascular salvage of a failing pectoralis major myocutaneous flap

While being elevated prior to reconstruction of a left-sided neck defect, a pectoralis major myocutaneous island flap was rendered ischemic by the inadvertant transection of the pectoral branch of the thoracoacromial artery. In order to save the flap, a microvascular repair between the distal end of this vessel and the ascending branch of the transverse cervical artery was performed. The flap was successfully revascularized and the patient went on to uneventful healing with 100% flap viability. This technique could be used following similar technical error in the elevation of any axial pattern flap providing that suitable vessels for repair were present.

Effects of a Tongue Reconstructed with a Pectoralis Major Myocutaneous Island Flap on Vowel Formants in a Patient with Hemiglossectomy

Effects of a Tongue Reconstructed with a Pectoralis Major Myocutaneous Island Flap on Vowel Formants in a Patient with Hemiglossectomy

Pectoralis major myocutaneous island flap revisited: a sentinel vessel simplifying dissection.

AbstractSurgical extirpation of advanced cancers of the head and neck almost always requires extensive resections that invariably necessitate some sort of large flap for reconstruction. In recent years immediate one‐stage reconstruction of large defects in the area of the tonsillar fossa and the pharynx have been facilitated by the development of myocutaneous flaps, especially the pectoralis major myocutaneous flap. With this flap, immediate one‐step reconstruction at the time of the initial operation is accomplished. Myocutaneous flaps, however, require more skill and concentration in their elevation than do skin flaps in order to preserve the axial feeder vessel running along the underside of the muscle and supplying the all‐important perforating vessels to the overlying muscles and skin. We have noticed a constant perforating vessel, approximately 2‐cm long, coming off the pectoral branch of the thoracoacromial artery medial to the cephalic vein and 2 cm below the border of the clavicle. This pierces the substance of the overlying pectoralis major muscle and runs anteriorly into the subcutaneous fatty hypodermal layer. This vessel accurately localizes the position of the proximal portion of the pectoral branch of the thoracoacromial artery before elevation of the pectoralis major muscle has been started. The imaginary line joining this vessel and the island skin flap allows simplicity in elevation of the muscle pedicle and obviates fear of transecting the arterial supply to the skin island during the dissection. We have found the vessel to be present in 26 consecutive cases over the last 12 months. We present our findings of a sentinel vessel localizing the pectoral branch of the thoracoacromial artery as a guide in liberating the muscular paddle and axial artery in elevation of pectoralis major myocutaneous island flaps.

下いん頭・けい部食道がん治療の進歩 切除手術と再建手術

Complete resection and primary reconstruction are both the most important factors in the treatment of hypopharyngeal and cervical esophageal cancers. In order to secure the resection level superiorly at the oropharynx and inferiorly at cervical esophagus, margin studies of extirpated specimens were done. About 20% of examined cases showed positive margins at the oropharyngeal stump and 10% at the esophageal stump. Cancers extending below the level of Th2 showed a high incidence of skip lesions in the lower esophagus. Specimens of early pyriform sinus cancers, which were extirpated with the preservation of the larynx, showed positive margins only in a few cases and only at their oropharyngeal margins.These results indicate that hypopharyngeal cancers may have a deep invasion' into the oropharynx and should be resected high up to the level of the palatine tonsil, and that total esophagectomy is advisable in case with cervical esophageal cancers to eliminate possible skippings.The reconstructive technique should be selected to ensure better matching to these defects. One-stage reconstruction is essential, enabling an earlier application of postoperative therapy. Staged technique is thus abandoned. Among many options of one-stage techniques, we prefer the pectoralis major myocutaneous island flap for hypopharyngeal cancers and vascularized stomach or colon for cervical esophageal cancers. Several technical devices were demonstrated in the use of the pectoralis major myocutaneous flap for female patients with buxom breast, otherwise the flap is not indicated because of its bulkiness.

Reconstruction of the axilla with a pectoralis major myocutaneous island flap

The pectoralis major myocutaneous island flap is useful for axillary reconstruction following resection of tumour and skin in the axilla. It is a useful alternative to the latissimus dorsi flap, particularly when the vascular pedicle of the latissimus dorsi muscle is infiltrated by tumour or has been sacrificed by previous surgery.

The vascular anatomy of the pectorals major myocutaneous flap

The vascular anatomy of the pectoralis major muscle and overlying skin and subcutaneous tissue was investigated in seventeen cadaver specimens by cannulation of the arterial supply and injection of contrast medium. A rich anastomosis between the internal mammary artery and the pectoral branch of the thoraco-acromial artery and between the pectoral branch and the lateral thoracic artery was demonstrated. In 36% of cases a major axial cutaneous vessel, originating close to the thoraco-acromial artery, was shown to extend caudad. The lateral thoracic artery, in addition to the pectoral branch, contributed significantly to the vascularity of the pectoralis major muscle and was the main blood supply to the female breast. The skin overlying the muscle was abundantly supplied from the muscle vasculature. Both the major arteries were enclosed within the muscle's fascial envelope. A technique for developing a standard pectoralis major myocutaneous island flap is described. Our studies show that a hemichest flap incorporating all the skin of the chest over the muscle is feasible.

Pectoralis major myocutaneous island flap in head and neck surgery: Analysis of complications in 42 cases.

The pectoralis myocutaneous island flap was used for head and neck reconstruction in 42 patients. Major necrosis did not occur in any case, and minor necrosis was present in three of the cases (7%). The advantages of this flap over other myocutaneous flaps and cutaneous pedicle flaps are delineated.

A one-stage flap reconstruction following resection for stomal recurrence.

The pectoralis major myocutaneous island flap has been used for a one-stage reconstruction following ablative surgery for stomal recurrence. The skin island of this flap is supplied by the perforating musculature vessels of the thoracicoacromial artery. The flap can be elevated primarily and is used in a one-stage reconstruction. The new stoma is created in the center of the skin island, and the great vessels are covered by the pectoralis major muscle pedicle. The surgical technique as performed in seven successful cases is presented.

Primary Reconstruction of the Cervical Esophagus with a Pectoralis Major Myocutaneous Island Flap

Technical details of a primary reconstruction of the cervical esophagus using pectoralis major myocutaneous island flap were discussed with some clinical case reports. Versatility of this flap was stressed along with some shortcomings, being compared with DP skin flap. Conclusions are as follows;1. Pectoralis major myocutaneous island flap is good enough to reconstruct the cervical esophagus after removing extensive cancer in the hypopharynx.2. Patients can begin to swallow in 19th postoperative day on the average, which is much shorter than 53rd in patients with DP skin flap.3. Delay procedure is unnecessary in every case.4. Thoracoacromial artery runs down on the anterior chest wall so in constant position that the designing of the flap is technically easy.5. Postoperative care is extremely simple.6. There may be no danger of flap necrosis and resultant stenosis.7. The flap may not be indicated for a woman with a buxom breast.8. The flap may not be indicated for a woman with a thick subdermal adipose tissue.