The Pectoralis Major Myocutaneous Flap

Ken G. W. Teo; Warren M. Rozen; Rafael Acosta

doi:10.1055/s-0033-1343832

Journal of Reconstructive Microsurgery, Inhaltsverzeichnis

J Reconstr Microsurg 2013; 29(07): 449-456
DOI: 10.1055/s-0033-1343832

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Pectoralis Major Myocutaneous Flap

Ken G. W. Teo

¹Department of Plastic and Reconstructive Surgery, Geelong Hospital, Bellerine, Australia

,

Warren M. Rozen

¹Department of Plastic and Reconstructive Surgery, Geelong Hospital, Bellerine, Australia

,

Rafael Acosta

¹Department of Plastic and Reconstructive Surgery, Geelong Hospital, Bellerine, Australia

› Institutsangaben

Abstract

Introduction The pectoralis major myocutaneous flap (PMMF) is a workhorse flap for head and neck reconstruction and a flap of choice for anterior chest wall reconstruction.

Methods A thorough review of the literature was undertaken, exploring the full range of designs, variations, indications, and outcomes of the PMMF.

Results Numerous modifications have been documented since it was first described in 1968. Complication rates vary greatly in the literature, but most institutions describe significant success with the PMMF. It is fast, versatile, reliable, and a good alternative when microsurgical flap failure occurs. A classification system of skin paddles is presented.

Conclusion In the era of free tissue transfer, the PMMF still has its advantages and continues to command an important place in the reconstructive surgeon's armamentarium.

Keywords

pectoralis major - myocutaneous - pedicled - flap - reconstruction

Volltext

Referenzen

References
1 Hueston JT, McConchie IH. A compound pectoral flap. Aust N Z J Surg 1968; 38 (1) 61-63
2 Ariyan S. The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck. Plast Reconstr Surg 1979; 63 (1) 73-81
3 Ariyan S. Further experiences with the pectoralis major myocutaneous flap for the immediate repair of defects from excisions of head and neck cancers. Plast Reconstr Surg 1979; 64 (5) 605-612
4 Mathes SJ, Nahai F. Classification of the vascular anatomy of muscles: experimental and clinical correlation. Plast Reconstr Surg 1981; 67 (2) 177-187
5 Wei WI, Lam KH, Wong J. The true pectoralis major myocutaneous island flap: an anatomical study. Br J Plast Surg 1984; 37 (4) 568-573
6 Shank EC, Patow CA. The pectoralis major flap. Ear Nose Throat J 1992; 71 (4) 161-165
7 Sasaki CT, Gardiner LJ, Carlson RD, Vris T. The extended pectoralis major flap in head and neck reconstruction. Otolaryngol Head Neck Surg 1986; 94 (3) 274-278
8 Kruse AL, Luebbers HT, Obwegeser JA, Bredell M, Grätz KW. Evaluation of the pectoralis major flap for reconstructive head and neck surgery. Head Neck Oncol 2011; 3 (3) 12
9 Biller HF, Baek SM, Lawson W, Krespi YP, Blaugrund SM. Pectoralis major myocutaneous island flap in head and neck surgery: Analysis of complications in 42 cases. Arch Otolaryngol 1981; 107 (1) 23-26
10 Baek SM, Lawson W, Biller HF. An analysis of 133 pectoralis major myocutaneous flaps. Plast Reconstr Surg 1982; 69 (3) 460-469
11 Brusati R, Collini M, Bozzetti A, Chiapasco M, Galioto S. The pectoralis major myocutaneous flap. Experience in 100 consecutive cases. J Craniomaxillofac Surg 1988; 16 (1) 35-39
12 Fabian RL. Pectoralis major myocutaneous flap reconstruction of the laryngopharynx and cervical esophagus. Laryngoscope 1988; 98 (11) 1227-1231
13 Bell MS, Barron PT. The rib-pectoralis major osteomyocutaneous flap. Ann Plast Surg 1981; 6 (5) 347-353
14 Green MF, Gibson JR, Bryson JR, Thomson E. A one-stage correction of mandibular defects using a split sternum pectoralis major osteo-musculocutaneous transfer. Br J Plast Surg 1981; 34 (1) 11-16
15 Ascherman JA, Patel SM, Malhotra SM, Smith CR. Management of sternal wounds with bilateral pectoralis major myocutaneous advancement flaps in 114 consecutively treated patients: refinements in technique and outcomes analysis. Plast Reconstr Surg 2004; 114 (3) 676-683
16 Zbar RI, Funk GF, McCulloch TM, Graham SM, Hoffman HT. Pectoralis major myofascial flap: a valuable tool in contemporary head and neck reconstruction. Head Neck 1997; 19 (5) 412-418
17 Corten EM, Hage JJ, Schellekens PP, Kreulen M, Kon M. Clinical application and outcome of the segmental pectoralis major free flap in five head and neck patients. Plast Reconstr Surg 2009; 123 (5) 1462-1467
18 Liu R, Gullane P, Brown D, Irish J. Pectoralis major myocutaneous pedicled flap in head and neck reconstruction: retrospective review of indications and results in 244 consecutive cases at the Toronto General Hospital. J Otolaryngol 2001; 30 (1) 34-40
19 Liu HL, Chan JY, Wei WI. The changing role of pectoralis major flap in head and neck reconstruction. Eur Arch Otorhinolaryngol 2010; 267 (11) 1759-1763
20 Russell RC, Feller AM, Elliott LF, Kucan JO, Zook EG. The extended pectoralis major myocutaneous flap: uses and indications. Plast Reconstr Surg 1991; 88 (5) 814-823
21 Crosher R, Llewelyn J, Mitchell R. A modification of the pectoralis major myocutaneous flap that reduces the defect at the donor site. Ann R Coll Surg Engl 1995; 77 (5) 389-391
22 Iblher N, Penna V, Momeni A, Padron NT, Stark GB. The extended pectoralis major flap for reconstruction of the upper posterior chest wall and axilla. J Thorac Cardiovasc Surg 2008; 136 (3) 790-791 , e1–e13
23 Magee Jr WP, McCraw JB, Horton CE, McInnis WD. Pectoralis “paddle” myocutaneous flaps. The workhorse of head and neck reconstruction. Am J Surg 1980; 140 (4) 507-513
24 Reid CD, Taylor GI. The vascular territory of the acromiothoracic axis. Br J Plast Surg 1984; 37 (2) 194-212
25 Freeman JL, Gullane PJ, Rotstein LM. The double paddle pectoralis major myocutaneous flap. J Otolaryngol 1985; 14 (4) 237-240
26 Ord RA, Avery BS. Side-by-side double paddle pectoralis major flap for cheek defects. Br J Oral Maxillofac Surg 1989; 27 (3) 177-185
27 Haers PE, Grätz KW, Sailer HF. The bilobed myocutaneous pectoralis major flap in closure of combined intra- and extraoral defects. Int J Oral Maxillofac Surg 1994; 23 (4) 214-218
28 Espinosa MH, Phillip JA, Khatri VP, Amin AK. Double skin island pectoralis major myocutaneous flap with nipple-areola complex preservation: a case report. Head Neck 1992; 14 (6) 488-491
29 Mao C, Yu GY, Peng X, Zhang L, Guo CB, Huang MX. [Combined free flap and pedicled pectoralis major myocutaneous flap in reconstruction of extensive composite defects in head and neck region: a review of 9 consecutive cases]. Hua Xi Kou Qiang Yi Xue Za Zhi 2006; 24 (1) 53-56
30 Chen HC, Demirkan F, Wei FC, Cheng SL, Cheng MH, Chen IH. Free fibula osteoseptocutaneous-pedicled pectoralis major myocutaneous flap combination in reconstruction of extensive composite mandibular defects. Plast Reconstr Surg 1999; 103 (3) 839-845
31 Murakami Y, Saito S, Ikari T, Haraguchi S, Okada K, Maruyama T. Esophageal reconstruction with a skin-grafted pectoralis major muscle flap. Arch Otolaryngol 1982; 108 (11) 719-722
32 Phillips JG, Postlethwaite K, Peckitt N. The pectoralis major muscle flap without skin in intra-oral reconstruction. Br J Oral Maxillofac Surg 1988; 26 (6) 479-485
33 Lee KY, Loré Jr JM. Two modifications of pectoralis major myocutaneous flap (PMMF). Laryngoscope 1986; 96 (4) 363-367
34 Spiess AM, Balakrishnan C, Gursel E. Fascial release of the pectoralis major: a technique used in pectoralis major muscle closure of the mediastinum in cases of mediastinitis. Plast Reconstr Surg 2007; 119 (2) 573-577
35 Weaver AW, Vandenberg HJ, Atkinson DP, Wallace JR. Modified bilobular (“gemini”) pectoralis major myocutaneous flap. Am J Surg 1982; 144 (4) 482-488
36 Abe S, Ide Y, Iida T, Kaimoto K, Nakajima K, Ide Y. Vascular consideration in raising the pectoralis major flap. Bull Tokyo Dent Coll 1997; 38 (1) 5-11
37 Dieckmann J, Koch A. [Primary reconstruction of the mandible with a pedicled muscle and bone transplant—the pectoralis major and rib flap]. Fortschr Kiefer Gesichtschir 1994; 39: 87-89
38 Phillips JG, Falconer DT, Postlethwaite K, Peckitt N. Pectoralis major muscle flap with bone graft in intra-oral reconstruction. Br J Oral Maxillofac Surg 1990; 28 (3) 160-163
39 Turkmen A, Perks AG. Endoscopic assisted harvest of the pedicled pectoralis major muscle flap. Br J Plast Surg 2005; 58 (2) 170-174
40 Chaturvedi P, Pathak KA, Pai PS, Chaukar DA, Deshpande MS, D'Cruz AK. A novel technique of raising a pectoralis major myocutaneous flap through the skin paddle incision alone. J Surg Oncol 2004; 86 (2) 105-106
41 Krespi YP, Wurster CF, Sisson GA. A longer muscle pedicle for pectoralis myocutaneous flap. Laryngoscope 1983; 93 (10) 1360-1361
42 Iblher N, Penna V, Momeni A, Padron NT, Stark GBJ. The extended pectoralis major flap for reconstruction of the upper posterior chest wall and axilla. J Thorac Cardiovasc Surg 2008; 136 (3) 790-791 , e1–e13
43 Lin H, Hou C, Xu Z. Transfer of the superior portion of the pectoralis major flap for restoration of shoulder abduction. J Reconstr Microsurg 2009; 25 (4) 255-260
44 Mosahebi A, Da Lio A, Mehrara BJ. The use of a pectoralis major flap to improve internal mammary vessels exposure and reduce contour deformity in microvascular free flap breast reconstruction. Ann Plast Surg 2008; 61 (1) 30-34
45 Kruse AL, Luebbers HT, Grätz KW, Bredell M. A new method for closure of large donor side defects after raising the pectoralis major flap. Oral Maxillofac Surg 2011; 15 (4) 251-252
46 Talesnik A, Markowitz B, Calcaterra T, Ahn C, Shaw W. Cost and outcome of osteocutaneous free-tissue transfer versus pedicled soft-tissue reconstruction for composite mandibular defects. Plast Reconstr Surg 1996; 97 (6) 1167-1178
47 Shah JP, Haribhakti V, Loree TR, Sutaria P. Complications of the pectoralis major myocutaneous flap in head and neck reconstruction. Am J Surg 1990; 160 (4) 352-355
48 Wilson JS, Yiacoumettis AM, O'Neill T. Some observations on 112 pectoralis major myocutaneous flaps. Am J Surg 1984; 147 (2) 273-279
49 Mehta S, Sarkar S, Kavarana N, Bhathena H, Mehta A. Complications of the pectoralis major myocutaneous flap in the oral cavity: a prospective evaluation of 220 cases. Plast Reconstr Surg 1996; 98 (1) 31-37
50 Kroll SS, Evans GR, Goldberg D , et al. A comparison of resource costs for head and neck reconstruction with free and pectoralis major flaps. Plast Reconstr Surg 1997; 99 (5) 1282-1286
51 Huang RD, Silver SM, Hussain A, Parnes SM, Wing PD. Pectoralis major myocutaneous flap: analysis of complications in a VA population. Head Neck 1992; 14 (2) 102-106
52 Kroll SS, Goepfert H, Jones M, Guillamondegui O, Schusterman M. Analysis of complications in 168 pectoralis major myocutaneous flaps used for head and neck reconstruction. Ann Plast Surg 1990; 25 (2) 93-97
53 Lam KH, Wei WI, Siu KF. The pectoralis major costomyocutaneous flap for mandibular reconstruction. Plast Reconstr Surg 1984; 73 (6) 904-910
54 Baek SM, Biller HF, Krespi YP, Lawson W. The pectoralis major myocutaneous island flap for reconstruction of the head and neck. Head Neck Surg 1979; 1 (4) 293-300
55 von Biberstein SE, Spiro JD. The pectoralis major myocutaneous flap in reconstructive head and neck surgery revisited: a recent experience. Conn Med 1994; 58 (12) 711-714
56 Novakovic D, Patel RS, Goldstein DP, Gullane PJ. Salvage of failed free flaps used in head and neck reconstruction. Head Neck Oncol 2009; 1: 33
57 Chana JS, Odili J. Perforator flaps in head and neck reconstruction. Semin Plast Surg 2010; 24 (3) 237-254
58 Blackwell KE. Unsurpassed reliability of free flaps for head and neck reconstruction. Arch Otolaryngol Head Neck Surg 1999; 125 (3) 295-299
59 Schuller DE. Limitations of the pectoralis major myocutaneous flap in head and neck cancer reconstruction. Arch Otolaryngol 1980; 106 (11) 709-714
60 Agha FP, Wimbish KJ. Hirsute esophagus: clinical and roentgen features. Gastrointest Radiol 1984; 9 (4) 297-300
61 van Rossen ME, Verduijn PV, Mureau MA. Survival of pedicled pectoralis major flap after secondary myectomy of muscle pedicle including transection of thoracoacromial vessels: does the flap remain dependent on its dominant pedicle?. J Plast Reconstr Aesthet Surg 2011; 64 (3) 323-328
62 Avery CM, Crank ST, Neal CP, Hayter JP, Elton C. The use of the pectoralis major flap for advanced and recurrent head and neck malignancy in the medically compromised patient. Oral Oncol 2010; 46 (11) 829-833
63 Milenović A, Virag M, Uglesić V, Aljinović-Ratković N. The pectoralis major flap in head and neck reconstruction: first 500 patients. J Craniomaxillofac Surg 2006; 34 (6) 340-343
64 Dedivitis RA, Guimarães AV. Pectoralis major musculocutaneous flap in head and neck cancer reconstruction. World J Surg 2002; 26 (1) 67-71
65 Ord RA. The pectoralis major myocutaneous flap in oral and maxillofacial reconstruction: a retrospective analysis of 50 cases. J Oral Maxillofac Surg 1996; 54 (11) 1292-1295 , discussion 1295–1296
66 IJsselstein CB, Hovius SE, ten Have BL , et al. Is the pectoralis myocutaneous flap in intraoral and oropharyngeal reconstruction outdated?. Am J Surg 1996; 172 (3) 259-262
67 Pikani J, Ulla A, Tuulik E. Clinical evaluation of the pectoralis major flap for reconstruction in head and neck cancer. Scand J Plast Reconstr Surg Hand Surg 1994; 28 (3) 217-223
68 Keidan RD, Kusiak JF. Complications following reconstruction with the pectoralis major myocutaneous flap: the effect of prior radiation therapy. Laryngoscope 1992; 102 (5) 521-524
69 Kasler M, Banhidy FG, Trizna Z. Experience with the modified pectoralis major myocutaneous flap. Arch Otolaryngol Head Neck Surg 1992; 118 (9) 931-932
70 Ossoff RH, Wurster CF, Berktold RE, Krespi YP, Sisson GA. Complications after pectoralis major myocutaneous flap reconstruction of head and neck defects. Arch Otolaryngol 1983; 109 (12) 812-814
71 Mehrhof Jr AI, Rosenstock A, Neifeld JP, Merritt WH, Theogaraj SD, Cohen IK. The pectoralis major myocutaneous flap in head and neck reconstruction. Analysis of complications. Am J Surg 1983; 146 (4) 478-482
72 Maisel RH, Liston SL, Adams GL. Complications of pectoralis myocutaneous flaps. Laryngoscope 1983; 93 (7) 928-930