Extended pectoralis major myocutaneous flap in head and neck reconstruction

Abstract

Although the pectoralis major myocutaneous flap is often used in head and neck reconstruction, the extension of the skin paddle beyond the inferior limits of the muscle has not been well described. We aim to clarify the design and application of this extended flap in head and neck reconstruction. In this retrospective study, consecutive cases of extended pectoralis major myocutaneous flap reconstruction of post-ablative head and neck defects at a single tertiary referral center were included for analysis. In 7 cases an extended pectoralis major flap was utilized, in which the skin paddle was extended beyond the inferior border of the pectoralis major to include the rectus sheath. Skin and soft tissue as well as composite defects of the oral cavity, parotid/temporal region and neck were reconstructed. All flaps healed satisfactorily with no loss of skin viability. The extended pectoralis major myocutaneous flap is robust and has versatile applications for reconstruction of large, high and three dimensionally complex defects in the head and neck region.

Keywords: Head and neck cancer, Surgical flaps, Pedicle flap, Pectoralis major, Extended flap

Core tip: The current report describes the indications, design and technique of the extended pectoralis major flap in reconstructing challenging defects in the head and neck region. The flap has been shown to be safe and robust, and offers an important reconstructive option.