Evaluation Of The Subclavicular Route For The Pectoralis Major Flap In Oral And Maxillofacial Reconstruction-Our 15 Years Experience
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Abstract
Introduction: The pectoralis major flap (PMF) is an important reconstructive tool for defects in the head and neck region but excessive bulk and a limited arc of rotation can be problematic. These problems can be addressed by passing the pedicle deep to the clavicle but some authors feel that this modification may compromise the vitality off the flap. In the current article, these problems have been addressed by using a modified method.Materials and Methods: During the past 15 years (2000 to 2014) 182 head and neck cancer patients were treated for primary reconstruction following tumor ablation. PMF was modified by passing the pedicle deeply to the clavicle. Following flap harvest, the pedicle was passed in the subclavicular plane for reconstruction.Results: It was possible to increase the average length of PMF to 2.5-3.5cm compared to the supraclavicular route by using this modification. Minor complications were observed in 9 of 182 cases (5%): Partial flap necrosis occurred in 6 cases and fistula formation was observed in 3 cases. Conclusion: The subclavicular route increases the length and arc of rotation without compromising vascular supply to a higher degree compared to the conventional supraclavicular route. Furthermore, this concept decreases the bulk of the flap pedicle which is functionally and cosmetically favourable. Keywords: Pectoralis major flap; Subclavicular route; Head and neck reconstruction; Pedicle flap.
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2. Baek SM, Biller HF. Krespi Y, et. Al. The pectoralis major myocutaneous island flap for reconstruction of the head and neck. Head Neck Surg 1979; 1:293-300
3. Lenert JJ , Evans GRD. Oral Cavity Reconstruction .In: Mathes SJ, Hentz VR . Plastic Surgery. 2nd ed. Philadelphia, PA: Saunders,2006: 917- 956.
4. Varvares MA, Cheney ML. Pedicled Flaps. In: Cheney ML: Facial Surgery. 1st ed. Baltimore, Maryland :Williams & Wilkins, 1997: 466-469.
5. Standring S. Gray’s anatomy. 39th ed. London, UK: Churchill Livingstone, 2005.
6. Fabian R. Reconstruction of the laryngopharynx and cervical oesophagus. Laryngoscope1984; 94:1334-1350.
7. Lee K, Lore J. Two modifications of pectoralis major myocutaneous flap (PMMF). Laryngoscope1986; 96:363-367.
8. Wilson J, Yiacaimettis A, O’Neill T. Some observations on 112 pectoralis major myocutaneous flaps. Am J Surg 1994; 147:273-279.
9. De Azevedo J. Modified pectoralis major muocutaneous flap with partial preservation of the muscle: a study of 55 cases. Head Neck Surg1986; 8:327-331.
10. Hoffmann TK, Balló H, Hauser U, Bier H. The subclavicular route for the pectoralis major myocutaneous flap. HNO 2005; 54:523-527
11. CJ Kerawala, J Sun, Z Zhang, Z Guoyu.The pectoralis major myocutaneous flap: Is the subclavicular route safe? Head & neck 2001; 23: 879-884.
| Files | ||
| Issue | Vol 10, No 4 (Autumn 2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jcr.v10i4.15308 | |
| Keywords | ||
| Pectoralis major flap Subclavicular route Head and neck reconstructi Pedicle fla | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Garajei A, Arab Kheradmand A, Emami A. Evaluation Of The Subclavicular Route For The Pectoralis Major Flap In Oral And Maxillofacial Reconstruction-Our 15 Years Experience. J Craniomaxillofac Res. 2024;10(4):167-171.
