Vascular consideration in raising the pectoralis major flap

Several types of musculocutaneous flaps, including that the pectoralis major, have been used for reconstruction following resection of malignant tumors in the head and neck region. Although several clinical studies have investigated the vascularity of such musculocutaneous flaps, the findings have been inconsistent. The present study examined the distribution of arteries in the pectoralis major muscle and surrounding subcutaneous tissue by macroscopic dissection and angiography. Based on the results of this examination, muscle layer and surrounding subcutaneous tissue appear to be supplied by different arteries and show different distribution patterns. However, evidence of penetrating branches from the muscle layer to the subcutaneous tissue layer suggests the existence of blood flow from the muscle layer to the subcutaneous tissue layer. Such arterial branches should be considered when raising the pectoralis major flap in order to prevent necrosis and improve the viability of the flap.