Sternal osteomyelitis with or without mediastinal infection is a severe and rare complication of median sternotomy. Done in an appropriate manner as outlined here, the extended flap increases the versatility of pectoralis major myocutaneous flap. Although freetissue transfer is often preferred, the benefits of the pmmf should not be. The procedure is quick and does not need a separate reconstructing team as in our case where the same surgeon did the reconstruction. Pectoralis major the authors 2018 myocutaneous flap in. Pectoralis major myocutaneous flap in head and neck. The reliability of pectoralis major myocutaneous flap in head. In 15 cases of subtotal pharyngolaryngectomy, the posterior. T1 pectoralis major myocutaneous flap reconstruction of the mandible. Pectoralis major myocutaneous flap how is pectoralis major myocutaneous flap abbreviated. The pectoralis major myocutaneous flap and myofascial flap variation are utilized in a large variety of head and neck reconstructive procedures. An immediate reconstructive surgery with a pectoralis. Ideas and innovations local transposition flap repair of.
It is plausible that some of the complications reported previously with the pectoralis major flap 8,9 might have been avoided by utilizing the extended flap. Pectoralis major myocutaneous flap and myofascial flap see also. Reconstruction following the 19 surgeries was achieved with a primary closure in 4 cases, a local advancement flap in 4, a splitthickness skin graft in 3, a pectoralis major myocutaneous flap in 3, a radial forearm free flap in 3, a trapezius flap in 1, and a scapula flap in 1 table 2. Pectoralis major myocutaneous flap for hypopharyngeal. Pectoralis major muscle and deltopectoral side by side flap for. The pectoralis major myocutaneous flap in mediastinal. The pedicled pectoralis major myocutaneous pmmc flap is versatile, and is widely used for the treatment of surgical defects following oral cancer resection.
In a retrospective study of a series of 211 consecutive patients undergoing pec toralis major myocutaneous flap recon struction, shai et al. An anatomical understanding of the pectoralis muscle and its vasculature is of paramount importance to the surgeon. The skin paddle extended below the level of the muscle and was raised as a fasciocutaneous flap on the aponeurosis of the rectus abdominis in this region. Pedicled flaps in head and neck surgery slideshare. Notice elevation of anterior rectus sheath, but not rectus abdominis muscle, in caudad portion of wound. An immediate reconstructive surgery with a pectoralis major.
Pectoralis major myocutaneous flap pmmc with deltopectoral flap was done to cover the defect. The pectoralis major musculocutaneous pmmc flap has been a useful technique for head and neck reconstruction since its first description by ariyan in 1979. Pectoralis major turnover versus advancement flap for. Background a 270degree partially tubed pectoralis major myocutaneous flap pmmf is an excellent option for total circumferential pharyngoesophageal defects in patients who are not candidates for more complex reconstructions. Pedicled latissimus dorsi myocutaneous flap for large neck defect reconstruction z fang1, j he1, s jin1, y zhang2, y he1 a variety of local, regional or distant flaps, depending on the specific needs of the patient. In this paper, an alternative technique for the reconstruction of sternal defects with the use of bilateral pectoralis major pedicled muscle flaps is presented. The pectoralis major muscle is composed of the clavicular and sternocostal heads. The pectoralis major flap johan fagan the pectoralis major flap comprises the pectoralis major muscle, with or without overlying skin, and may include the underlying ribs. Indications the pectoralis major myocutaneous flap and myofascial flap variation are utilized in a large variety of head and neck reconstructive procedures that can include coverage of mucosal andor cutaneous defects.
To evaluate the problem, we studied the vascular supply to the pmmf, specifically, the lateral thoracic artery lta and the pectoral. Download as an information leaflet pdf pectoralis major flap. Pectoralis major myocutaneous flap how is pectoralis major. Pectoralis major myocutaneous flap hns preferences. A projecting or hanging piece usually attached to something on one side and often intended to protect or cover. Pectoralis major myocutaneous flap for head and neck. Pectoralis major flap british association of oral and. The medical charts of the 12 participating patients were retrospectively re viewed for. The reliability of pectoralis major myocutaneous flap in. Case example of pectoralis myocutaneous flap general considerations. Many reports of the trapezius myocutaneous flap have centered on a single form of the flap. This study aimed to compare the results of the pectoralis major myocutaneous pmm flap in primary and salvage head and neck cancer surgery. The pectoralis major myocutaneous flap pmmf is a safe and versatile flap used widely for head and neck cancer reconstructions, but one of the major and most feared complications is oro or pharyngocutaneous fistula.
Pectoralis major myocutaneous flap flashcards quizlet. Pectoralis major myocutaneous flap for head and neck defects. Stephan ariyan in the late 1970s for reconstruction of ablative surgical defects in patients with head and neck cancer. In 1979, ariyan was the first to describe the use of the pmmc flap in head and neck reconstruction. Since its introduction by ariyan in 1979, the pectoralis major myocutaneous flap pmmf has been used as a workhorse flap for the reconstruction of the head and neck defects in the following three. The role of the pectoralis major myocutaneous flap pmmf in head and neck reconstruction is challenged recently due to its natural drawbacks. The pectoralis major myocutaneous flap pmmf is a commonly used. Jun 04, 2016 one of the earliest methods described involved development of the pectoralis major pm myocutaneous flap, which was first used by dr. Pectoralis major flap vula university of cape town. We experienced only one failure of the flap in a patient in whom the right pmf had been previously used in the head and neck area and who underwent ligation of the left innominate vein during the procedure. Pectoralis major myocutaneous flap in salvage reconstruction following free flap failure in head and neck cancer surgery wei wei 1, yongsheng qiu2, qigen fang3 and yingping jia1 abstract objective. Ariyan7,8,9 introduced the pectoralis major myocutaneous flap to head and neck surgery. Extended pectoralis major myocutaneous flap in head and.
Indications and outcomes for pedicled pectoralis major. Done in an appropriate manner as outlined here, the extended flap increases the versatility of pectoralis major myocutaneous flap in head and neck reconstruction. The pectoralis major myocutaneous flap in head and neck. As for the technique of harvesting the pmmf, the skin island needs to be designed principally medial to and at the level of the nipple. Pectoralis major turnover versus advancement flap for sternal wound reconstruction. Pectoralis major myocutaneous flap reconstruction in headandneck malignancy experience from a tertiary care center d amudhan1, k kannan2 1senior assistant professor, department of surgical oncology, government thoothukudi medical college, thoothukudi, tamil nadu, india. The first reports of pectoralis major myocutaneous flap pmmf appeared in the literature in 1968 by dr hueston, a surgeon from melbourne australia, where he described incorporating the pectoralis muscle with the overlying skin to reconstruct chest wall defects. Pectoralis major myocutaneous flap and myofascial flap. This paper discusses the pectoralis major myocutaneous flap, its anatomy, preparation, and dissection, for use in head and neck reconstruction.
In recent developments in the repair of large surgical defects where simple flap rotation may have been previously employed, myocutaneous flaps are being used because of functional advantages and to decrease the number of reconstructive procedures. Apr 11, 2020 in a free flap procedure, the surgeon cuts a graft from one area of the body and transfers it to another. In 22 cases of total pharyngolaryngectomy, the reconstructive procedure originally proposed by the authors was based on the use of a pectoralis major myocutaneous flap directly sutured to the pharyngeal and esophageal stumps and the prevertebral fascia, which eventually represented the posterior wall of the neohypopharynx. The reliability of pectoralis major myocutaneous flap in head and neck reconstruction.
The pectoralis major myocutaneous flap pmmc flap represents a landmark in the development of head and neck reconstructive surgery. Pedicled latissimus dorsi myocutaneous flap for large neck. Pmf, including the entire pectoralis major muscle, was routinely used for amt reconstruction. Myocutaneous flap definition of myocutaneous flap by. The platysma myocutaneous flap dates back to 1887 when an austrian surgeon, robert gersuny, described repair of a cheek defect. Combined free vascularized iliac osteocutaneous flap and.
The treatment of sternal wound complications is controversial. The extent of coverage and the reach of the flap are dependent on the anatomy of the patient but the upper limits are generally considered the zygomatic arch externally and the tonsillar bed internally. What is a pectoralis major myocutaneous flap used for. It has an axial blood supply and is based superiorly on the pectoral branch of the thoracoacromial artery.
Pectoralis major myocutaneous flap was found to be a versatile flap for reconstruction of. Jun 04, 2016 the pectoralis major myocutaneous pmmc flap has always been considered the workhorse flap for oral, head, and neck reconstruction. Pmmf pectoralis major myocutaneous flap acronymfinder. Objective to examine our outcomes with skin paddle survival using pectoralis myocutaneous flaps in reconstruction of the head and neck. The mission of the ahns is to advance education, research, and quality of care for the head and neck oncology patient. Extended pectoralis major myocutaneous flap in head and neck. However, it has several disadvantages, such as chest distortion, hair growth at the reconstructed site, and excessive bulk, all of which can be avoided by the use of the pectoralis myofascial flap. The cause of necrosis was speculative in each case. The pectoralis major myocutaneous flap has been associated with a notable incidence of distal skin necrosis and flap loss. Vascular anatomy of the pectoralis major myocutaneous flap. This is the most commonly used pedicled flap for the reconstruction of tumor adn traumarelated defects fo the oral and maxillofacial region. The pectoralis major myocutaneous pedicled flap revisited.
Pdf pectoralis major myocutaneous flap in head and neck. Anatomy of pectoralis major the pectoralis major is a flat triangular fan shaped muscle lying on the anterior and superior aspect of the chest wall. Pectoralis major myocutaneous flap pocket dentistry. In spite of its size, no significant donor functional deficit results from removal of the muscle. Pectoralis major myocutaneous flap for reconstruction of. It has a limited arc of rotation and a division of the flap is necessary as a second proceduce. The pectoralis major myofascial flap for intraoral and. Pectoralis major myocutaneous flap reconstruction of the.
In a series of 43 pectoralis major myocutaneous flaps pmmf, five 12% developed partial or total necrosis. Pectoralis major myocutaneous flap local and regional. The pectoralis major myocutaneous flap pocket dentistry. Elevation of myocutaneous flap in plane deep to pectoralis major muscle. Pectoralis major myocutaneous flap in head and neck reconstruction 1. Pectoralis major myocutaneous flaps for head and neck. Pdf the pectoralis major myocutaneous pedicled flap. An alternative technique for surgical management of.
The mucosal and skin defects are closed by two skin paddles. Rotated flaps involve cutting out a myocutaneous flap while leaving part of the tissue attached. Flap territory the pectoralis major myocutaneous flap pmmf is useful in head and neck reconstruction. The problems and complications encountered have been found to be minimal. After harvesting the myocutaneous flap, the whole pectoralis major muscle together with the skin paddle is turned upward to the head and neck region. For example, if a patient is missing skin on the arm due to a burn injury, the surgeon could cut a flap from the leg.
Myocutaneous flaps commonest reconstructive option for head and neck defects include. However, three distinct myocutaneous segments, the superior, the lateral island, and the extended island flaps, can be harvested from the trapezius muscle and its overlying skin. A 70yearold man with the diagnosis of poststernotomy osteomyelitis underwent. Department of otorhinolaryngology, head and neck surgery ent. The pectoralis major myocutaneous pmmc flap has been used as a versatile and reliable flap since its first description by ariyan in 1979. Although the use of micro vascular free flaps is a reliable procedure, the pectoralis major myocutaneous flap is still applicable for selected.
The pectoralis major myocutaneous flap sciencedirect. With his modification in technique of harvesting the flap. The pectoralis major myocutaneous flap pmmf remains a useful flap for head and neck reconstruction. However, techniques in microvascular surgery have since evolved and recently free tissue transfer has played an important role in head and neck reconstruction. Several authors have commented upon the versatility of the bilobed pec toralis major myocutaneous flap. The medical history revealed that the patient was surgically operated 4 years back by a wide resection of the tumor with left hemimandibulectomy without disarticulation, left radical neck dissection and reconstruction with pectoralis major myocutaneous flap.
A modified pectoralis major myocutaneous flap technique with. Doublepaddled pectoralis major myocutaneous flap as an. Full article pdf 12 academic content and language evaluation of this article citation of this article corresponding author of this article publishing process of this article. Pectoralis major myocutaneous flap in head and neck surgery. Ld myocutaneous flap is not a good option because although it provides a large muscle flap to cover the defect but has a limitation in the availability of size of skin paddle. The latissimus dorsi muscle is the largest muscle in the body, up to 20 by 40 centimeters, allowing coverage of extremely large wounds.
Mar 02, 2015 pectoralis major myocutaneous flap in head and neck reconstruction 1. We present our experience with pectoralis major myocutaneous flap in. Unlike microvascular free flap, 5th rib osteo pectoralis major myocutaneous flap reconstruction is quick with an average time of 1 h to raise and place the flap. Yet, it was only introduced to the english literature in 1978 by futrell et al, 1 and since then, it has become established as an attractive reconstructive alternative with several potential advantages. Nov 21, 2017 pec major muscle to reconstruct a skin defect after tl head and neck reconstruction. Radical debridement and appropriate antibiotic and antifungal treatment was started. Pmmc flap was used to cover mucosal defect in 84 patients, skin defects in 10 patient and both in 6 patients bipaddled. Pectoralis major myocutaneous pedicle flap is harvested in the standard fashion with the following considerations an adequate length of the flap must be ensured to allow a skin paddle of adequate size to reach to the oral cavity defect without tension. Pectoralis major myocutaneous flap reconstruction in head.
The current report describes the indications, design and technique of the extended pectoralis major flap in reconstructing challenging. Summary pectoralis major myocutaneous flap reconstruction of the defect following surgery for oral cancer in fourteen patients is described. Composite resection, guide flange prosthesis, maxillary obturator, squamous cell carcinoma ntroduction squamous cell carcinoma scc of the oral cavity accounts for 4% of malignancies in men and 2% of malignancies in women, and is. Operative technique experience with a newly developed pectoralis the muscle is approached through an incision major myocutaneous flap. The plane of elevation should include the sternocleidomastoid fascia, as. Evaluation of the pectoralis major flap for reconstructive head and. The bilobed myocutaneous pectoral is major flap in closure of. One of the greatest advantages of the pectoralis major myocutaneous flap is the quality and quantity of tissue that can be harvested. Pectoralis major myocutaneous flap and myofascial flap iowa. The pectoralis major myocutaneous flap has definite advantages over other myocutaneous flaps used in closing heap and neck defects. The surgical technique used to harvest the pmmf was as described in the literature,7,10,18,23 and is depicted in figure 1 ac. Doublepaddled pectoralis major myocutaneous flap as an alternative to microvascularized free flaps in complex orocervical defects plastic and aesthetic research is an open acccess journal, which publishes articles on technical and clinical studies related to plastic and aesthetic surgery. The trapezius myocutaneous flap requires a skin graft to the donor area and there is a temporary orocutaneous fistula. Pectoralis major myocutaneous flap reconstruction was done as a primary procedure in 95 patients, and 5 were salvage procedures reconstruction after fistula and coverage of exposed mandibular prosthesis.
These instruments were applied to the hemiglossectomy with bilateral neck dissection and immediate reconstruction with a pectoralis major myocutaneous flap for a 64yearold woman with squamous cell carcinoma of the right tongue stage t4an2bm0. It is our practice to combine early aggressive debridement, a modified robicsek sternal closure, and bilateral pectoralis major advancement flaps with or without closed irrigation in a single procedure. The muscle lying over the clavicle will produce a prominent bulge. The role of the pectoralis major myocutaneous flap pmmf in head and neck reconstruction is challenged recently due to its natural drawbacks and the popularity of free flaps. For large complex defects, the latissimus dorsi myocutaneous flap and pectoralis major myocutaneous flap are com. Pectoralis major myocutaneous flap is a soft tissue reconstructive surgical procedure that provides oral lining and facial cover of soft tissue defects. On the 14th day mucormycosis was noted on pectoralis major myocutaneous flap donor site. The pectoralis major myocutaneous pedicle flap pmmf is still being employed by many surgeons and plays an important role in head and neck reconstruction 15. Full article pdf 11 academic content and language evaluation of this article. The pectoralis myocutaneous flap has been widely used for reconstruction of oral cavity and pharyngeal defects. First described in 1947 but not used for head and neck construction until 1979. In india head and neck cancer patients usually present in the advanced stage making pmmc flap a viable option for.
Although we use free flaps as the first choice for head and neck. Jan 08, 2016 pedicled flaps in head and neck surgery 1. Myocutaneous definition of myocutaneous by medical dictionary. Myocutaneous flap definition of myocutaneous flap by the. After stephan ariyan first described its use for head and neck reconstruction in 1979, it has become tremendously popular and has revolutionised head and neck cancer surgery. Major myocutaneous pmm flap, deltopectoral dp flap, etc. The pectorals major myocutaneous flap is not only a versatile flap but also a very reliable and robust one for single stage immediate head and neck reconstruction 16. Department signed memorandums of understanding for academic collaboration with three mainland china institutions, namely, the otolaryngology hospital of the first affiliated hospital of sun yatsen university, guangzhou. Pectoralis major myocutaneous flaps for head and neck reconstruction. Platysma myocutaneous flap its current role in reconstructive surgery of oral soft tissue defects 5 skin paddle up to the mandible, leaving the platysma down. Extended pectoralis major myocutaneous flap in head and neck reconstruction. Pectoralis major myocutaneous flap in head and neck reconstruction by dr. Indications and outcomes for pedicled pectoralis major myocutaneous flaps at a primary microvascular head and neck reconstructive center 104.
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