A method that preserves circulation during preparation of the pectoralis major myocutaneous flap in head and neck reconstruction

The present article describes a method that preserves circulation during th e preparation of the pectoralis major myocutaneous flap used in head and ne ck reconstruction. The major disadvantage of this flap is its poor circulat ion and consequent partial necrosis. To solve this problem, we analyzed the circulation and hemodynamics of the pectoralis major myocutaneous flap (th e perforator of the anterior intercostal branch located about 1 to 2 cm med ial to the areola in the fourth intercostal space is important), evaluated the safe donor sites in the chest wall for a skin island (the perforator is included on the skin island's central axis), improved the surgical procedu re for elevating flaps (for preventing perforator injuries), and devised a means to transfer flaps, thereby increasing the range of the flaps (the tra nsfer route is under the clavicle). Using this technique, head and neck reconstruction was performed on 62 pati ents. The diagnosis included oral cancer (21), oropharyngeal carcinoma (10) , parotid carcinoma (10), hypopharyngeal carcinoma (9), and other head and neck malignant tumors (12). Of these, partial or marginal necrosis of the f lap caused by circulatory problems was detected in three patients (5 percen t). Using our method, the problems associated with inadequate circulation i n the pectoralis major myocutaneous flap were greatly alleviated, thus reco nfirming the usefulness of this flap in head and neck reconstruction.