Modified bilobular ("gemini") pectoralis major myocutaneous flap

Area of Science:

• Plastic Surgery
• Head and Neck Reconstruction
• Surgical Oncology

Background:

• Large mucocutaneous defects in the head and neck often require complex, multi-stage reconstructive procedures.
• Previous methods, including combined myocutaneous and deltopectoral flaps, presented challenges in achieving satisfactory closure.
• The need for a simplified, single-stage solution for extensive defects was apparent.

Observation:

• The bilobular (gemini) type of pectoralis major myocutaneous flap utilizes two skin paddles on a single vascularized muscle pedicle.
• The muscle is folded between the skin paddles, maintaining its vascular axis.
• This technique allows for simultaneous closure of both mucosal and skin components of the defect.

Findings:

• All evaluated defects were successfully closed using the bilobular pectoralis major myocutaneous flap.
• A significant portion of the skin grafts survived, indicating flap viability.
• The procedure proved effective in single-stage reconstruction following tumor ablation or complication management.

Implications:

• This flap offers a streamlined approach to managing complex head and neck defects, reducing the need for multiple surgeries.
• It provides a reliable method for reconstructing through-and-through mucocutaneous defects.
• The technique enhances reconstructive capabilities in head and neck cancer surgery and post-complication management.