New Pectoralis major musculocutaneous flap with a midline sternal skin paddle for head and neck reconstruction: A new design

Abstract

Background: The pectoralis major musculocutaneous (PMMC) flap is a classic flap used for reconstruction of the head and neck. It is been relatively unpopular with the advancement of microsurgery and liberal use of free flaps. The classic parasternal paddle design provided a thick flap with small rotation arch while leaving objectionable scarring. Our new symmetric midsternal design overcomes these problems

Patients and methods Patients were reviewed retrospectively from the year 2000 to 2015. The flap's skin paddle was placed in the midsternal area by designing symmetrically on both sides of the midsternal line. The pectoralis muscle (PM) and aponeurosis were attached in the lateral 1/2 of skin paddle. Almost the whole PM was elevated on the with thoracoacromial vessels and dissected till the main trunk, where PM was cut and used for bulk. The flap was transferred to the neck and lower mandibular area. The flap was inset either supraclavicularly covering the anterior neck or infraclavicularly for intraoral/maxillary defects. Sterilized plastic bags were used and pulled for pulling the flap through the tunnel for infraclavicular route.

Results A total of 7 patients underwent head and neck reconstruction using the PMMC flap with a sternal skin paddle between the years 2000 and 2015. The etiology of the defect was radiation necrosis in 3 of the patients, repair of cutaneous fistula in 3 of the patients, and recurrent hypopharyngeal cancer in 1 patient. There was no flap loss or major complications

Conclusion With the advancement of microsurgical liberal free flap techniques of high success rates, the classic flaps have been less popular. Even so, PMMC was an option for head & neck reconstruction with its many advantages. Our new midsternal PMMC design supplements the PMMC flap by providing a thin pliable flap with long pedicle, rotation arc allowing combination of different types of flaps to cover composite head & neck defects. It is especially a favorable option in cases without a reliable recipient vessel, due to radiation.