Marking and planning for pectoralis major myo cutaneous flap. Pectoralis major muscle flaps pmmf are a commonly used reconstructive modality to repair head and neck defects. The goal of this book is to remind the biomechanical and anatomical basis of these tendon transfers and to report tips and tricks and results of these. For a larger tissue requirement a double pedicled flap may be used 2. Nuts and bolts of pmmc flap in oral cancer and its clinical. The pectoralis major is a thick, fanshaped muscle, situated at the chest of the human body. Indications and outcomes for pedicled pectoralis major myocutaneous flaps at a primary microvascular head and neck reconstructive center 106 in our series, 5 out of the 6 patients 83% who devel oped complications had a history of preoperative radio therapy, while only 1 of 6 patients 17% who did not. A novel technique of raising a pectoralis major myocutaneous flap th. A 72yearold man with a history of hypertension and emphysema. The primary closure group without pectoralis major flap included 14 patients, and the group with. In some patients, however, this technique is not advisable. Pectoralis major myocutaneous flap pocket dentistry. Outpatient rehabilitation for a postoperative thyroid cancer.
Following ariyans 3 publication in 1979, withers at al 4 described the technique of folding the skin island of a pm flap into a tube for the reconstruction of circumferential pharyngectomy defects. In female patients with large breasts or thick subcutaneous fat, the flap cannot be utilized because of its bulkiness, and a newly developed technique that uses a skingrafted pectoralis major muscle flap is indicated. Tendon transfer for irreparable cuff tear philippe. The pectoralis flap has, however, not been relegated to the history books. Excisional surgery of hypopharyngeal cancer and primary. The concurrent use of both flaps has enabled elucidation of some specific and relative advantages and disadvantages.
The origins of deltopectoral flaps and the pectoralis. When the authors develop what appears to be a new surgical technique, the authors are prone to be excited. The pectoralis major myocutaneous pedicle flap pmmf is still being used by many surgeons and plays an important role in head and neck reconstruction. 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. The foundation of this book is their personal experience and teaching caseload. Beginning with an introduction to the history of the procedure, the following sections. Marking and planning the pmmc flap is very essential for successful and precise raising of the flap which is the workhorse for head and neck reconstruction. Secondary flap options, such as the omental flap or rectus abdominis muscle, may occasionally be necessary. Chiu 34 pectoralis major flap, 396 william ignace wei, chan yu wai expert commentary hungchi chen 35 deltopectoral flap and internal mammary artery perforator flap, e87 j. In our series, no total necrosis of the flap occurred. Pedicled flaps in head and neck surgery slideshare. Clinical atlas of muscle and musculocutaneous flaps. However, these flaps consisted of only epithelium and some subcutaneous tissue and therefore were not appropriate for defects in which bulk had.
In essence, a rectangular or trapezoid skin island was designed over the pectoralis major muscle, which was transferred together with its supplying blood. Failure of the subscapularis and anterior in front supraspinatus, leads to weakness and pain on activities that require pushing across the front of the body, such as lifting and gripping a heavy weight in front of you. Pectoralis major myocutaneous flap in head and neck reconstruction. Jan 08, 2016 the lateral margin of the pectoralis major is identified through wide undermining of the skin of lateral chest wall 9. Out of 5 patients with tl, 34 had a prior history of radiation. The same was repeated by y ikuta, t kubo, k tsuge japan. Repair of postlaryngectomy pharyngocutaneous fistulas using a. The pectoralis major muscle flap is the most commonly used muscle flap for reconstruction of sternal, anterosuperior chest, intrathoracic, and neck wounds. It is referred to as the workhorse flap of head and neck reconstruction. Contemporary role of pectoralis major regional flaps in head and.
The book, however, is a guide, and each surgeon interested in. In its long history, the pectoralis major flap has seen alternating indications. A simple technique to manage sternal wound dehiscence ctsnet. Jan 01, 2007 many authors have used the ipsilateral latissimus dorsi muscle and the rectus abdominis flap. No patient had partial or total necrosis of the flaps, only one of the scalp used in a previously irradiated patient presented an alteration in the venous return with temporal cyanosis. Independently, surgeons in china 1976 published in chinese performed free pectoralis major lateral part muscle flap to the forearm for finger flexion after vic. Omentum reconstruction of the breast plastic surgery key. Pectoralis major muscle is elevated off the chest wall by sharp and blunt dissection 11. Pectoralis major is a thick fan shaped muscle situated in the anterior chest wall. Twentyone female patients underwent a vertical breast reduction with the chest wallbased flap and were randomly divided into two subgroups. Pectoralis major myocutaneous flap is the most commonly used flap by head and neck surgeons due to their familiarity with the anterior chest and because the flap supplies bulk and has high success rates. A circumferential incision around the skin paddle has been completed, along with exposure of entire pectoralis major muscle. Dec 03, 2020 therefore, we do not agree that repair of the pectoralis muscle by reattaching to the chest wall, or putting the muscle back to its original place, would be separately reported.
This chapter talks about the pectoralis major muscle. Many tendon transfers are reported as latissimus dorsi, teres major, split of anterior deltoid and pectoralis major. Hybrid superdrained pectoralis major myocutaneous flap for early. Jul 30, 20 are used when you do pushups, when you clap your hands together, or flap your arms like wings. The pectoralis major flap has been considered the workhorse flap for chest and sternoclavicular defect reconstruction. 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. Deltopectoral flap an overview sciencedirect topics. The thoracoacromial artery is the major vascular supply to the flap. It remains as one of the main flaps for salvage reconstruction.
The pectoral major may colloquially be referred to as pecs, pectoral. Earlier than the advent of microvascular free flaps, ariyan in 1980 described the pectoralis major myocutaneous flap pmmc as a workhorse flap. Coding 23395 for pectoralis muscle repair karenzupko. Pectoralis major muscle flap use in a modern head and neck. The book, however, is a guide, and each surgeon interested in the field should use the book as it is intended. This atlas is a concise guide to the use of pectoralis major myocutaneous flap in head and neck reconstruction. Feb 11, 2021 independently, surgeons in china 1976 published in chinese performed free pectoralis major lateral part muscle flap to the forearm for finger flexion after vic. This video demonstrates construction of a mediastinal stoma after laryngotrachiectomy using a pectoralis major myocutaneous flap. The fascia of the pectoralis major muscle may be raised with the flap. Oct 06, 2020 the authors have used bilateral pectoralis major myocutaneous flaps based on the thoracoacromial pedicle to manage sternal wound dehiscence in 42 patients from 2003 2019. A novel technique to increase the length of tracheal resection by. The vast majority of skin flaps discussed in this textbook are local flaps.
Summary pectoralis major myocutaneous flap is a soft tissue reconstructive surgical procedure that provides oral lining and facial cover of soft tissue defects. May 23, 2014 the pectoralis major myocutaneous flap was first introduced by ariyan in 1979, and along with the forehead flap, it was the most commonly used flap for head and neck reconstruction in the early 1980s. A pectoralis major pedicled flap maintains its own blood supply and is one of the. Pectoralis major myocutaneous flap atlas of operative oral and. The pectoralis major myocutaneous flap pmmf is one of the workhorse flaps. The use of omentum flap is flexible, safe, and provides several solutions. Despite the attractiveness, feasibility and success rates of free tissue transfer, the role of the pectoralis major myocutaneous flap is irreplaceable in the setting of highrisk patients, the vesseldepleted neck, and in overall poor free tissue transfer surgical candidates. The pectoralis major myocutaneous flaps described by ariyan and baek are a hybrid of conleys laterally based deltopectoral flap and huestons inclusion of the pectoralis major muscle in the skin flap. The pectoralis major myocutaneous flap has enjoyed a long history of over 40 years utilization to reconstruct a variety of head and neck defects.
The main arterial supply for pectoralis major myocutaneous flap is the pectoral branch of acromiothoracic artery, which arises from the first part of. The pectoralis major s primary functions are flexion, adduction, and internal rotation of the humerus. With coverage of nearly twice the number of flaps as the previous edition, flaps and reconstructive surgery, 2nd edition provides trainees and practicing surgeons alike with the detailed, expert knowledge required to ensure optimal outcomes. Tendon transfer from periscapular muscles group is a therapeutic option. Onestage reconstruction for defects of the mouth using a sternomastoid myocutaneous flap. The pectoralis major flap is a reconstructive option to consider in the treatment. Pectoralis major myocutaneous flap atlas of operative oral.
Pectoralis major myocutaneous flap in head and neck reconstruction by dr. A 46yearold woman was referred with a history of dyspnea for 4 months. Jun 01, 2019 the pectoralis major myocutaneous flap has enjoyed a long history of over 40 years utilization to reconstruct a variety of head and neck defects. Videolaparoscopic approach is very safe, takes 6090 min, and provides good postoperative. Pectoralis major myofascial onlay and myocutaneous flaps. Ariyan7,8,9 introduced the pectoralis major myocutaneous flap to head and neck surgery. A versatile flap for reconstruction in the head and neck. Us and mr imaging of pectoralis major injuries radiographics. It also leads to weakness in pulling objects across the front of your body.
Oral intake after fistula repair with a pectoralis major flap was. Jun 01, 2019 despite the attractiveness, feasibility and success rates of free tissue transfer, the role of the pectoralis major myocutaneous flap is irreplaceable in the setting of highrisk patients, the vesseldepleted neck, and in overall poor free tissue transfer surgical candidates. Enjoy the videos and music you love, upload original content, and share it all with friends, family, and the world on youtube. It makes up the bulk of the chest muscles and lies under the breast. Flaps and reconstructive surgery by fuchan wei and samir.
Outpatient rehabilitation for a postoperative thyroid cancer patient with pectoralis major flap reconstruction and head and neck lymphedema. Marckk w 2003 a history of noma, the face of poverty. Pectoralis major myocutaneous flap in head and neck. Pectoralis major myocutaneous pmmc flap, based on the thoracoacromial artery. A capacious pharynx is essential for good swallowing and fistula speech. C lequang france first inferior gluteal myocutaneous free flap for breast. Free versus pedicled flaps for reconstruction of head and. Pectoralis major myocutaneous flap in head and neck surgery. A modified pectoralis major myocutaneous flap was used to stabilize necrotic neck wounds rapidly in irradiated patients. Pectoralis myocutaneous flap for salvage of necrotic wounds.
The pectoralis major myocutenous flap pmmc flap, dp flap, submental flap and forehead flap have been described for such reconstructions 1. Summary pectoralis major myocutaneous flap is a soft tissue reconstructive surgical procedure that provides oral lining and facial cover of soft. Reconstruction of the face following cancer ablation intechopen. Should tumour involve the hypopharynx, especially when it extends distally towards the cricopharyngeus, then the expertise must be available to possibly augment the pharyngeal repair with a pectoralis major flap. Temporalis flap pectoralis major myocutaneous flap. After stephan ariyan first described its use for head and neck reconstruction in 1979, it has become tremendously popular.
Musculocutaneous flap reconstruction of the head and neck. Ariyan s 1979 the pectoralis major myocutaneous flap. Mar 14, 2019 hsing cy, wong yk, wang cp, wang cc, jiang rs, chen fj, et al. The pectoralis major myocutaneous flap sciencedirect. One of the most common complications of total laryngectomy is pharyngocutaneous fistula, and management strategies for its resolution have long been discussed. Mar 02, 2015 pectoralis major myocutaneous flap in head and neck reconstruction by dr. Abstract the pectoralis major myocutaneous flap pmmc flap represents a landmark in the development of head and neck reconstructive surgery. Feb 21, 2016 the pectoralis major is then released on the sternal region to decrease function, avoiding lateral projection without losing coverage of the upper hemisphere of the implants.
The flap was a sandwich flap that included an overlying parasternal pectoral skin paddle for pharyngeal reconstruction, the pectoralis muscle for carotid protection, and a meshed skin graft applied to the undersurface of the muscle to replace cervical skin. These patients were originally operated on by various cardiac surgeons. If one flap is inadequate, a combination of flaps may be used. Jun 01, 2014 pectoralis major myocutaneous flap is the most commonly used flap by head and neck surgeons due to their familiarity with the anterior chest and because the flap supplies bulk and has high success rates. Fundamentals a voice disorders a disorders of language and hearing development european manual of medicine. Armed with this information, the trained surgeon can undertake flap transposition with an enhanced degree of safety and reliability.
In such cases regional flaps may present a reasonable option. The pectoralis major myocutaneous pedicled flap revisited. The pectoralis major from latin pectus breast is a thick, fanshaped muscle, situated at the chest of the human body. In most cases, pectoralis major myocutaneous advancement flaps provide excellent coverage while eliminating dead space and providing sternal compression. Anterior trunk, pectoralis major, serratus anterior, rectus abdominis, posterior trunk, latissimus dorsi, trapezius. Beneath the pectoralis major is the pectoralis minor, a thin, triangular muscle. Indications and outcomes for pedicled pectoralis major. Patients who undergo pectoralis major myocutaneous flap reconstruction experience higher complication rates and longer durations of hospitalization than those. Pectoralis major myocutaneous flap atlas of operative. The procedure was performed in a 53yearold patient who had a past history of squamous cell carcinoma of the right piriform sinus treated by supraglottic hemipharyngolaryngectomy. The main arterial supply for pectoralis major myocutaneous flap is the pectoral branch of acromiothoracic artery, which arises from the first part of axillary artery. Surgical configurations of the pectoralis major flap for reconstruction. Premium contentlogin to buy access to this content.
Innovative techniques in noma reconstructive surgery springerlink. Correction of polands deformity through a hemiareolar. Pectoralis major myofascial onlay and myocutaneous flaps and. Location of the skin paddle and incisions for the pectoralis major f1 ap. Coding for pectoralis major muscle tears in icd10 medical. Pectoralis major flap british association of oral and. Pectoralis myocutaneous flap for salvage of necrotic. The boomerangshaped pectoralis major musculocutaneous flap. Analysis of 120 pectoralis major flaps for head and neck.
Novel insights into pathological changes in muscular arteries of radiotherapy p. A left autologous pedicled pectoralis major myocutaneous flap 20. Nuts and bolts of pmmc flap in oral cancer and its. As the use of free flap reconstruction is increasingly practiced in the head and neck, the role of the pmmf may be changing as well. We believe this service is included in whatever codes you choose for the breast reconstruction procedure and separately reporting 23395 is not accurate. The pectoralis major myocutaneous flap pmmc flap represents a landmark in the development of head and neck reconstructive surgery.
Effects of radiotherapy on pharyngeal reconstruction after. It is an ideal flap based on its proximity, reliability, and versatility. The origins of deltopectoral flaps and the pectoralis major. The pectoralis major myocutaneous flap in head and neck. It includes chapters and expert commentaries from more than 100 authors and worldrenowned leaders in the field, while brandnew cases and highquality illustrations focused on flap. The deltopectoral flap v the pectoralis major myocutaneous. In this report, we describe a successful reconstruction of an extensive neck skin defect using a boomerangshaped pmmc flap. Comparison between free flap and pectoralis major pedicled flap for reconstruction in oral cavity cancer patientsa quality of life analysis. A novel technique of raising a pectoralis major myocutaneous flap through the.
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