Pectoralis major flap british association of oral and. The latissimus dorsi muscle is the largest muscle in the body, up to 20 by 40 centimeters, allowing coverage of extremely large wounds. Indications and outcomes for pedicled pectoralis major myocutaneous flaps at a primary microvascular head and neck reconstructive center 104. Pectoralis major myocutaneous flap in head and neck reconstruction by dr. Pmf, including the entire pectoralis major muscle, was routinely used for amt reconstruction. Doublepaddled pectoralis major myocutaneous flap as an alternative to microvascularized free flaps in complex orocervical defects plastic and aesthetic research is an open acccess journal, which publishes articles on technical and clinical studies related to plastic and aesthetic surgery. An anatomical understanding of the pectoralis muscle and its vasculature is of paramount importance to the surgeon. Pedicled latissimus dorsi myocutaneous flap for large neck. Nov 21, 2017 pec major muscle to reconstruct a skin defect after tl head and neck reconstruction. Myocutaneous definition of myocutaneous by medical dictionary.
The pectoralis major myocutaneous flap pmmf is a commonly used. Radical debridement and appropriate antibiotic and antifungal treatment was started. Jan 08, 2016 pedicled flaps in head and neck surgery 1. Department signed memorandums of understanding for academic collaboration with three mainland china institutions, namely, the otolaryngology hospital of the first affiliated hospital of sun yatsen university, guangzhou. The pectoralis major myocutaneous flap sciencedirect. The pectoralis major flap johan fagan the pectoralis major flap comprises the pectoralis major muscle, with or without overlying skin, and may include the underlying ribs.
The first reports of pectoralis major myocutaneous flap pmmf appeared in the literature in 1968 by dr hueston, a surgeon from melbourne australia, where he described incorporating the pectoralis muscle with the overlying skin to reconstruct chest wall defects. In this paper, an alternative technique for the reconstruction of sternal defects with the use of bilateral pectoralis major pedicled muscle flaps is presented. Platysma myocutaneous flap its current role in reconstructive surgery of oral soft tissue defects 5 skin paddle up to the mandible, leaving the platysma down. Free and regional flaps for head and neck reconstruction. In 22 cases of total pharyngolaryngectomy, the reconstructive procedure originally proposed by the authors was based on the use of a pectoralis major myocutaneous flap directly sutured to the pharyngeal and esophageal stumps and the prevertebral fascia, which eventually represented the posterior wall of the neohypopharynx. In 15 cases of subtotal pharyngolaryngectomy, the posterior. Download as an information leaflet pdf pectoralis major flap. Done in an appropriate manner as outlined here, the extended flap increases the versatility of pectoralis major myocutaneous flap in head and neck reconstruction.
The role of the pectoralis major myocutaneous flap pmmf in head and neck reconstruction is challenged recently due to its natural drawbacks. Pectoralis major myocutaneous flap in head and neck reconstruction 1. In a series of 43 pectoralis major myocutaneous flaps pmmf, five 12% developed partial or total necrosis. An immediate reconstructive surgery with a pectoralis.
Extended pectoralis major myocutaneous flap in head and neck. Full article pdf 12 academic content and language evaluation of this article citation of this article corresponding author of this article publishing process of this article. Reconstruction following the 19 surgeries was achieved with a primary closure in 4 cases, a local advancement flap in 4, a splitthickness skin graft in 3, a pectoralis major myocutaneous flap in 3, a radial forearm free flap in 3, a trapezius flap in 1, and a scapula flap in 1 table 2. Pectoralis major myocutaneous flap for hypopharyngeal. The pectoralis major myocutaneous flap pmmf is a safe and versatile flap used widely for head and neck cancer reconstructions, but one of the major and most feared complications is oro or pharyngocutaneous fistula. Pectoralis major myocutaneous flap in salvage reconstruction following free flap failure in head and neck cancer surgery wei wei 1, yongsheng qiu2, qigen fang3 and yingping jia1 abstract objective. Jun 04, 2016 one of the earliest methods described involved development of the pectoralis major pm myocutaneous flap, which was first used by dr. 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. Pmmf pectoralis major myocutaneous flap acronymfinder. The pectoralis major myocutaneous flap in mediastinal. Done in an appropriate manner as outlined here, the extended flap increases the versatility of pectoralis major myocutaneous flap. Pectoralis major turnover versus advancement flap for.
Case example of pectoralis myocutaneous flap general considerations. After harvesting the myocutaneous flap, the whole pectoralis major muscle together with the skin paddle is turned upward to the head and neck region. Although freetissue transfer is often preferred, the benefits of the pmmf should not be. Background a 270degree partially tubed pectoralis major myocutaneous flap pmmf is an excellent option for total circumferential pharyngoesophageal defects in patients who are not candidates for more complex reconstructions. Pectoralis major flap vula university of cape town.
Pectoralis major myocutaneous flap reconstruction in headandneck malignancy experience from a tertiary care center d amudhan1, k kannan2 1senior assistant professor, department of surgical oncology, government thoothukudi medical college, thoothukudi, tamil nadu, india. Unlike microvascular free flap, 5th rib osteo pectoralis major myocutaneous flap reconstruction is quick with an average time of 1 h to raise and place the flap. The skin paddle extended below the level of the muscle and was raised as a fasciocutaneous flap on the aponeurosis of the rectus abdominis in this region. The procedure is quick and does not need a separate reconstructing team as in our case where the same surgeon did the reconstruction. This paper discusses the pectoralis major myocutaneous flap, its anatomy, preparation, and dissection, for use in head and neck reconstruction. In 1979, ariyan was the first to describe the use of the pmmc flap in head and neck reconstruction.
We experienced only one failure of the flap in a patient in whom the right pmf had been previously used in the head and neck area and who underwent ligation of the left innominate vein during the procedure. Although we use free flaps as the first choice for head and neck. Pdf pectoralis major myocutaneous flap in head and neck. Pedicled flaps in head and neck surgery slideshare. The reliability of pectoralis major myocutaneous flap in. This study aimed to compare the results of the pectoralis major myocutaneous pmm flap in primary and salvage head and neck cancer surgery. Pectoralis major myocutaneous pedicle flap is harvested in the standard fashion with the following considerations an adequate length of the flap must be ensured to allow a skin paddle of adequate size to reach to the oral cavity defect without tension. Pectoralis major turnover versus advancement flap for sternal wound reconstruction. Pectoralis major myocutaneous flap pocket dentistry. An immediate reconstructive surgery with a pectoralis major.
It has a limited arc of rotation and a division of the flap is necessary as a second proceduce. The muscle lying over the clavicle will produce a prominent bulge. Pectoralis major myocutaneous flap was found to be a versatile flap for reconstruction of. Many reports of the trapezius myocutaneous flap have centered on a single form of the flap. The bilobed myocutaneous pectoral is major flap in closure of. It has an axial blood supply and is based superiorly on the pectoral branch of the thoracoacromial artery. Myocutaneous flap definition of myocutaneous flap by the.
Combined free vascularized iliac osteocutaneous flap and. The pectoralis major myocutaneous pmmc flap has been used as a versatile and reliable flap since its first description by ariyan in 1979. The pectoralis major myocutaneous flap pmmc flap represents a landmark in the development of head and neck reconstructive surgery. The pectoralis major myocutaneous flap and myofascial flap variation are utilized in a large variety of head and neck reconstructive procedures. Extended pectoralis major myocutaneous flap in head and. Pectoralis major myocutaneous flap hns preferences. The cause of necrosis was speculative in each case. The pectoralis major myocutaneous flap pocket dentistry.
Vascular anatomy of the pectoralis major myocutaneous flap. Several authors have commented upon the versatility of the bilobed pec toralis major myocutaneous flap. The mucosal and skin defects are closed by two skin paddles. This is the most commonly used pedicled flap for the reconstruction of tumor adn traumarelated defects fo the oral and maxillofacial region. Ideas and innovations local transposition flap repair of. Myocutaneous flap definition of myocutaneous flap by. 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. A projecting or hanging piece usually attached to something on one side and often intended to protect or cover. Pectoralis major muscle and deltopectoral side by side flap for. Pectoralis major myocutaneous flap how is pectoralis major myocutaneous flap abbreviated. The pectoralis major musculocutaneous pmmc flap has been a useful technique for head and neck reconstruction since its first description by ariyan in 1979. Pectoralis major myocutaneous flap how is pectoralis major. Pedicled latissimus dorsi myocutaneous flap for large neck defect reconstruction z fang1, j he1, s jin1, y zhang2, y he1 a variety of local, regional or distant flaps, depending on the specific needs of the patient.
Pectoralis major myocutaneous flaps for head and neck. Ld myocutaneous flap is not a good option because although it provides a large muscle flap to cover the defect but has a limitation in the availability of size of skin paddle. Indications and outcomes for pedicled pectoralis major. Pectoralis major myocutaneous flap in head and neck surgery. Indications the pectoralis major myocutaneous flap and myofascial flap variation are utilized in a large variety of head and neck reconstructive procedures that can include coverage of mucosal andor cutaneous defects. Objective to examine our outcomes with skin paddle survival using pectoralis myocutaneous flaps in reconstruction of the head and neck. The medical charts of the 12 participating patients were retrospectively re viewed for. The platysma myocutaneous flap dates back to 1887 when an austrian surgeon, robert gersuny, described repair of a cheek defect. Notice elevation of anterior rectus sheath, but not rectus abdominis muscle, in caudad portion of wound. Pectoralis major myocutaneous flap in head and neck.
For example, if a patient is missing skin on the arm due to a burn injury, the surgeon could cut a flap from the leg. Pec major muscle to reconstruct a skin defect after tl head and neck reconstruction. To evaluate the problem, we studied the vascular supply to the pmmf, specifically, the lateral thoracic artery lta and the pectoral. It is our practice to combine early aggressive debridement, a modified robicsek sternal closure, and bilateral pectoralis major advancement flaps with or without closed irrigation in a single procedure. Pmmc flap was used to cover mucosal defect in 84 patients, skin defects in 10 patient and both in 6 patients bipaddled. Department of otorhinolaryngology, head and neck surgery ent. The surgical technique used to harvest the pmmf was as described in the literature,7,10,18,23 and is depicted in figure 1 ac. A 70yearold man with the diagnosis of poststernotomy osteomyelitis underwent. Pectoralis major the authors 2018 myocutaneous flap in. The medical history revealed that the patient was surgically operated 4 years back by a wide resection of the tumor with left hemimandibulectomy without disarticulation, left radical neck dissection and reconstruction with pectoralis major myocutaneous flap. With his modification in technique of harvesting the flap. In recent developments in the repair of large surgical defects where simple flap rotation may have been previously employed, myocutaneous flaps are being used because of functional advantages and to decrease the number of reconstructive procedures. Flap territory the pectoralis major myocutaneous flap pmmf is useful in head and neck reconstruction.
Although the use of micro vascular free flaps is a reliable procedure, the pectoralis major myocutaneous flap is still applicable for selected. After stephan ariyan first described its use for head and neck reconstruction in 1979, it has become tremendously popular and has revolutionised head and neck cancer surgery. Pectoralis major myocutaneous flap pmmc with deltopectoral flap was done to cover the defect. The pectoralis myocutaneous flap has been widely used for reconstruction of oral cavity and pharyngeal defects. T1 pectoralis major myocutaneous flap reconstruction of the mandible.
The pectorals major myocutaneous flap is not only a versatile flap but also a very reliable and robust one for single stage immediate head and neck reconstruction 16. For large complex defects, the latissimus dorsi myocutaneous flap and pectoralis major myocutaneous flap are com. In a retrospective study of a series of 211 consecutive patients undergoing pec toralis major myocutaneous flap recon struction, shai et al. Pectoralis major myocutaneous flaps for head and neck reconstruction. Pdf the pectoralis major myocutaneous pedicled flap. Ariyan7,8,9 introduced the pectoralis major myocutaneous flap to head and neck surgery. Operative technique experience with a newly developed pectoralis the muscle is approached through an incision major myocutaneous flap. The mission of the ahns is to advance education, research, and quality of care for the head and neck oncology patient. Mar 02, 2015 pectoralis major myocutaneous flap in head and neck reconstruction 1.
Evaluation of the pectoralis major flap for reconstructive head and. Extended pectoralis major myocutaneous flap in head and neck reconstruction. Stephan ariyan in the late 1970s for reconstruction of ablative surgical defects in patients with head and neck cancer. Doublepaddled pectoralis major myocutaneous flap as an. The pectoralis major myocutaneous flap has been associated with a notable incidence of distal skin necrosis and flap loss. Yet, it was only introduced to the english literature in 1978 by futrell et al, 1 and since then, it has become established as an attractive reconstructive alternative with several potential advantages. However, techniques in microvascular surgery have since evolved and recently free tissue transfer has played an important role in head and neck reconstruction. Pectoralis major myocutaneous flap for reconstruction of.
Pectoralis major myocutaneous flap for head and neck. The pectoralis major myocutaneous pedicle flap pmmf is still being employed by many surgeons and plays an important role in head and neck reconstruction 15. Sternal osteomyelitis with or without mediastinal infection is a severe and rare complication of median sternotomy. Pectoralis major myocutaneous flap local and regional. The pectoralis major myofascial flap for intraoral and. Summary pectoralis major myocutaneous flap reconstruction of the defect following surgery for oral cancer in fourteen patients is described. Elevation of myocutaneous flap in plane deep to pectoralis major muscle. The pectoralis major myocutaneous flap pmmf remains a useful flap for head and neck reconstruction. A modified pectoralis major myocutaneous flap technique with. Pectoralis major myocutaneous flap and myofascial flap iowa. We present our experience with pectoralis major myocutaneous flap in. It is plausible that some of the complications reported previously with the pectoralis major flap 8,9 might have been avoided by utilizing the extended flap. Composite resection, guide flange prosthesis, maxillary obturator, squamous cell carcinoma ntroduction squamous cell carcinoma scc of the oral cavity accounts for 4% of malignancies in men and 2% of malignancies in women, and is. Pectoralis major myocutaneous flap and myofascial flap see also.
Full article pdf 11 academic content and language evaluation of this article. First described in 1947 but not used for head and neck construction until 1979. Pectoralis major myocutaneous flap flashcards quizlet. Anatomy of pectoralis major the pectoralis major is a flat triangular fan shaped muscle lying on the anterior and superior aspect of the chest wall. However, it has several disadvantages, such as chest distortion, hair growth at the reconstructed site, and excessive bulk, all of which can be avoided by the use of the pectoralis myofascial flap. As for the technique of harvesting the pmmf, the skin island needs to be designed principally medial to and at the level of the nipple. The pectoralis major myocutaneous pedicled flap revisited. The plane of elevation should include the sternocleidomastoid fascia, as.
The trapezius myocutaneous flap requires a skin graft to the donor area and there is a temporary orocutaneous fistula. An alternative technique for surgical management of. The pectoralis major myocutaneous flap in head and neck. The extent of coverage and the reach of the flap are dependent on the anatomy of the patient but the upper limits are generally considered the zygomatic arch externally and the tonsillar bed internally. The pectoralis major muscle is composed of the clavicular and sternocostal heads. Rotated flaps involve cutting out a myocutaneous flap while leaving part of the tissue attached. The skin defect was covered by the skin paddle of the iliac osteocutaneous flap and a contralateral rotational pectoralis major muscle flap. Pectoralis major myocutaneous flap in head and neck reconstruction. The current report describes the indications, design and technique of the extended pectoralis major flap in reconstructing challenging. Pectoralis major myocutaneous flap reconstruction in head. Pectoralis major myocutaneous flap reconstruction was done as a primary procedure in 95 patients, and 5 were salvage procedures reconstruction after fistula and coverage of exposed mandibular prosthesis.
The pectoralis major myocutaneous flap has definite advantages over other myocutaneous flaps used in closing heap and neck defects. Pectoralis major myocutaneous flap reconstruction of the. Myocutaneous flaps commonest reconstructive option for head and neck defects include. Apr 11, 2020 in a free flap procedure, the surgeon cuts a graft from one area of the body and transfers it to another. The pedicled pectoralis major myocutaneous pmmc flap is versatile, and is widely used for the treatment of surgical defects following oral cancer resection. The reliability of pectoralis major myocutaneous flap in head and neck reconstruction. In spite of its size, no significant donor functional deficit results from removal of the muscle. What is a pectoralis major myocutaneous flap used for. In india head and neck cancer patients usually present in the advanced stage making pmmc flap a viable option for. On the 14th day mucormycosis was noted on pectoralis major myocutaneous flap donor site. However, three distinct myocutaneous segments, the superior, the lateral island, and the extended island flaps, can be harvested from the trapezius muscle and its overlying skin. The treatment of sternal wound complications is controversial. One of the greatest advantages of the pectoralis major myocutaneous flap is the quality and quantity of tissue that can be harvested. Major myocutaneous pmm flap, deltopectoral dp flap, etc.