Identification of Novel Surface Landmarks for Inframammary Pectoralis Major Myocutaneous Flap- A Prospective Single...

The inframammary skin paddle design of pectoralis major myocutaneous flap (PMMCF) is versatile with significant merits. However, lack of early identification of the vascular pedicle poses a risk on the flap integrity. This study aims to establish stable surface landmarks for identification of the pectoral branch of thoraco-acromial artery (PB-TAA), the chief vascular pedicle in PMMCF. A prospective observational study was planned and inframammary design of PMMCF was harvested to reconstruct defects secondary to oncologic resection of cancers of gingivobuccal complex. The mid-nipple line (NL) and xiphoid line (XL) were the proposed surface anatomical landmarks. The horizontal distance between the pedicle traversing in the deep surface of the pectoralis major muscle and the NL was measured. It is a single center prospective study. A total of 63 patients were included in the study. The distance of the PB-TAA from the NL was found to be 1.18 ± 0.48 cm medially and 0.8 ± 0.19 cm laterally. The mean differences between the medial and lateral pedicle locations were statistically significant (p < 0.01). This study suggests that the NL could prove to be a standard surface anatomical landmark for identification of vascular pedicle in inframammary skin paddle design of PMMCF.