PECTORALIS MAJOR MYOFASCIAL FLAP - A VALUABLE TOOL IN CONTEMPORARY HEAD AND NECK RECONSTRUCTION

Background. The pectoralis major myofascial (PMMF) unit is rapidly mob ilized, reliable, and extremely useful in a number of clinical situati ons calling for vascularized soft-tissue coverage in the head and neck . Although free-tissue transfer has emerged as the preferred method of reconstruction for a large variety of defects in the head and neck, t he pectoralis major muscle should be considered when vascularized soft -tissue coverage is required in this area. Methods. A retrospective ch art review of 24 PMMF flaps performed at the University of Iowa Hospit als and Clinics between January 1, 1991, and May 1, 1996, was undertak en. Outcomes were evaluated relative to accomplishing the established preoperative surgical goals. Results. Utilization of the PMMF flap was grouped according to four primary indications: (1) protection of thre atened great vessels or free flap vascular pedicles in situations of w ound break down due to fistula or infection (7 cases); (2) vascularize d soft-tissue coverage of great vessels or free-flap vascular pedicles acid prevention of potential wound breakdown in surgical defects in w hich compromised healing was anticipated (7 cases); (3) closure of sma ll pharyngeal defects (2 cases); or (4) vascularized coverage of the m andible following debridement for osteoradionecrosis (8 cases). The PM MF flap was 100% successful when the surgical goal was to protect expo sed vascular structures and promote wound healing in the presence of f istula or infection. The PMMF flap was 100% successful in the protecti on of vascular structures and prevention of wound breakdown in cases w here compromised wound healing was anticipated. The PMMF flap provided closure, and a vascularized surface for mucosalization, when used to primarily reconstruct small pharyngeal defects. The PMMF flap provided definitive closure in 5 of 8 (62.5%) cases of osteoradionecrosis of t he mandible when it was used to invest the remaining mandibular bone. Three of 8 cases (37.5%) required further surgical management and were considered failures, An acceptable cosmetic outcome was obtained in w omen undergoing this procedure by using an inframammary incision. The preoperative goal of the PMMF flap procedure was met in 21 of 24 (87.5 %) cases. There was a major complication rate of 12.5% as well as a mi nor complication rate of 12.5%. Conclusion. In cases requiring the pro tection of vital vascular structures from infection, salivary secretio ns or skin flap breakdown, the PMMF flap should be considered. The PMM F flap is an excellent reconstructive option in selected clinical situ ations, where vascularized soft-tissue coverage is required in the hea d and neck. (C) 1997 John Wiley & Sons, Inc.