Rotation of the clavicular portion of the pectoralis major for soft-tissuecoverage of the clavicle - An anatomical study and case report

Background: The purposes of this study were to describe the anatomical feat ures of a rotational flap consisting of the clavicular portion of the pecto ralis major and to report the surgical technique and the outcome of use of this flap in a patient with poor soft-tissue coverage following multiple op erations for a clavicular fracture complicated by nonunion and infection. Methods: Ten shoulders from five cadavera were dissected to isolate the cla vicular portion of the pectoralis major. The vascular pedicle, thoracoacrom ial artery, and axillary artery were identified, and the length of the vasc ular pedicle from the axillary artery to the muscle was measured. The angle of rotation of the nap about its intact clavicular origin was measured bef ore and after division of the acromial branch of the thoracoacromial artery . The clavicular origin was then incised, and the overall length, width, an d thickness of the muscle as well as the distance from each end of the musc le to the vascular pedicle were measured. Results: The average length of the vascular pedicle from the axillary arter y to the pectoralis muscle belly was 5.3 centimeters (range, 3.7 to 6.5 cen timeters). The average maximum angle of rotation with the clavicular origin intact was 60 degrees (range, 55 to 67 degrees) before division of the acr omial branch and 73 degrees (range, 65 to 82 degrees) after division. The a verage total length of the clavicular head,vas 20.2 centimeters (range, 18. 0 to 23.0 centimeters). The average width of the clavicular head was 2.9 ce ntimeters (range, 2.0 to 4.0 centimeters), and the average thickness was 0. 5 centimeter (range, 0.2 to 0.7 centimeter). The vascular pedicle entered t he muscle an average of 8.7 centimeters (range, 5.2 to 10.7 centimeters) la teral to the most medial extent of the muscle and an average of 11.5 centim eters (range, 9.5 to 14.0 centimeters) medial to the most lateral extent of the muscle, The rotational flap was successfully used clinically to provid e soft-tissue coverage after bone-grafting and internal fixation of a clavi cular nonunion that had been complicated by infection. Conclusions: The clavicular head of the pectoralis major may be used as a l ocal rotational flap to cover soft-tissue deficiencies over the clavicle. I t can be harvested with relative ease without damaging the sternocostal hea d.