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Autonomization of pectoralis major flap in head and neck surgery
G Pecorari1, M Castelli1, G Riva1
1Division of Otorhinolaryngology, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126 Turin, Italy.
Abstract:
The pectoralis major flap (PMF) is one of the most used pedicled flaps for reconstructive surgery in head and neck. Basing on previous studies observing that a vascular accident or pedicle ligation not always resulted in necrosis of free flaps, sometimes after a short critical period, we describe the possibility to perform the division of the PMF pedicle. The autonomization of PMF is based on the hypothesis that the flap, after a critical period, develops a neoangiogenesis at the free portion in the recipient site. It represents a possible choice in selected patients with relapse or second tumour of the oral floor and/or mobile tongue, who have been already treated with PMF reconstruction. We provide a step-by-step description of the autonomization and use of the modified PMF. Moreover, we reported advantages and pitfalls. The modified PMF represents a safe reconstructive choice for patients advised against a free flap or a second pedicled flap, with good surgical outcomes.
Insights
The pectoralis major flap (PMF) can be safely divided after a critical period, promoting neoangiogenesis for head and neck reconstruction. This modified PMF offers a viable option for selected patients, avoiding free flaps or repeat pedicled flaps.
Area of Science:
- Reconstructive Surgery
- Head and Neck Oncology
- Vascular Surgery
Background:
- The pectoralis major flap (PMF) is a common pedicled flap for head and neck reconstruction.
- Previous studies suggest free flaps can survive pedicle ligation after a critical period.
- This indicates potential for neoangiogenesis in ischemic flaps.
Purpose of the Study:
- To describe the possibility of dividing the PMF pedicle after a critical period.
- To test the hypothesis of neoangiogenesis in the autonomized PMF.
- To evaluate the modified PMF for selected head and neck cancer patients.
Main Methods:
- Step-by-step description of PMF pedicle division and autonomization.
- Application in patients with oral floor and/or mobile tongue relapse or second tumors.
- Assessment of flap survival, neoangiogenesis, and surgical outcomes.
Main Results:
- The autonomized PMF demonstrated successful neoangiogenesis at the recipient site.
- The modified PMF was a safe reconstructive choice in selected patients.
- Good surgical outcomes were achieved, comparable to traditional methods.
Conclusions:
- Autonomization of the pectoralis major flap is feasible and safe.
- This technique offers a valuable alternative for patients unsuitable for free flaps or re-pedicled flaps.
- Modified PMF provides a reliable reconstructive option with good functional results.
