A modified pectoralis major myocutaneous flap technique with improved vascular supply and an extended rotation arc for oral defects: A case report
- Authors:
- Takahiro Kanno
- Yoshiki Nariai
- Hiroto Tatsumi
- Masaaki Karino
- Aya Yoshino
- Joji Sekine
View Affiliations
Affiliations: Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane 693‑8501, Japan
- Published online on: September 14, 2015 https://doi.org/10.3892/ol.2015.3696
-
Pages:
2739-2742
-
Copyright: © Kanno
et al. This is an open access article distributed under the
terms of Creative
Commons Attribution License.
Metrics: Total
Views: 0 (Spandidos Publications: | PMC Statistics: )
Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )
This article is mentioned in:
Abstract
The pedicled pectoralis major myocutaneous (PMMC) flap is versatile, and is widely used for the treatment of surgical defects following oral cancer resection. Although free‑tissue transfer of a vascularized free flap is often preferred, the clinical benefits of the PMMC flap should not be overlooked. The conventional technique of harvesting a PMMC flap involves a single vascular supply from the pectoral branch of the thoracoacromial artery. However, this approach compromises the distal skin island of the flap, and requires an indirect blood supply via communicating vessels, which increases the potential risk of partial distal flap necrosis. When harvesting a PMMC flap for oral and maxillofacial reconstruction, preservation of the lateral thoracic artery and use of the subclavian route are alternatives that ensure sufficient blood supply and an increased rotation arc. Such an approach enables the harvesting of a PMMC flap that can reach the entire oral cavity, including the infraorbital region, palate, middle pterygopalatine fossa and nasopharynx, with no risk of vascular insufficiency to the distal skin island. In conclusion, the technique described in the present study was able to improve the blood supply of the distal PMMC flap and increase its rotation arc.
View References
|
1
|
Jena A, Patnayak R, Sharan R, Reddy SK,
Manilal B and Rao LM: Outcomes of pectoralis major myocutaneous
flap in female patients for oral cavity defect reconstruction. J
Oral Maxillofac Surg. 72:222–231. 2014. View Article : Google Scholar : PubMed/NCBI
|
|
2
|
Rikimaru H, Kiyokawa K, Watanabe K, Koga
N, Nishi Y and Sakamoto A: New method of preparing a pectoralis
major myocutaneous flap with a skin paddle that includes the third
intercostal perforating branch of the internal thoracic artery.
Plast Reconstr Surg. 123:1220–1228. 2009. View Article : Google Scholar : PubMed/NCBI
|
|
3
|
Yuen Po-Wing A: Preservation of lateral
thoracic artery to improve vascular supply of distal skin without
compromising pedicle length in harvesting pectoralis major
myocutaneous flap. J Plast Reconstr Aesthet Surg. 59:1433–1435.
2006. View Article : Google Scholar : PubMed/NCBI
|
|
4
|
Ariyan S: The pectoralis major
myocutaneous flap. A versatile flap for reconstruction in the head
and neck. Plast Reconstr Surg. 63:73–81. 1979. View Article : Google Scholar : PubMed/NCBI
|
|
5
|
Kiyokawa K, Tai Y, Tanabe HY, Inoue Y,
Yamauchi T, Rikimaru H, Mori K and Nakashima T: A method that
preserves circulation during preparation of the pectoralis major
myocutaneous flap in head and neck reconstruction. Plast Reconstr
Surg. 102:2336–2345. 1998. View Article : Google Scholar : PubMed/NCBI
|
|
6
|
Rikimaru H, Kiyokawa K, Inoue Y and Tai Y:
Three-dimensional anatomical vascular distribution in the
pectoralis major myocutaneous flap. Plast Reconstr Surg.
115:1342–1354. 2005. View Article : Google Scholar : PubMed/NCBI
|
|
7
|
Wei WI, Lam KH and Wong J: The true
pectoralis major myocutaneous island flap: An anatomical study. Br
J Plast Surg. 37:568–573. 1984. View Article : Google Scholar : PubMed/NCBI
|
|
8
|
National Comprehensive Cancer Network
(NCCN) Clinical Practice Guidelines in Oncology: Head and Neck
Cancers. Version 2. NCCN (Fort Washington, USA). 16–20. 2013.
|
|
9
|
Yang D, Marshall G and Morris SF:
Variability in the vascularity of the pectoralis major muscle. J
Otolaryngol. 32:12–15. 2003. View Article : Google Scholar : PubMed/NCBI
|
|
10
|
Elazab EEB and Nabil NM: Pectoralis major
muscle: Anatomical features of its arterial supply. Eur J Plast
Surg. 35:9–18. 2012. View Article : Google Scholar
|
|
11
|
Makiguchi T, Yokoo S, Miyazaki H, Takayama
Y, Ogawa M, Hashikawa K and Terashi H: Supercharged pectoralis
major musculocutaneous flap. J Craniofac Surg. 24:e179–e182. 2013.
View Article : Google Scholar : PubMed/NCBI
|
