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The osteomyocutaneous pectoralis major flap was first described in 1980 and provides a single stage reconstructive option for poor free flap or pectoralis major flap with reconstruction plate candidates requiring bony reconstruction. The flap provides good functional and cosmetic outcomes in appropriately selected patients. We describe the indications and operative techinique for harvesting this flap in written and video format. [ABSTRACT FROM AUTHOR]

Abstract: Background: This study compared the outcomes of an extensive segmental pectoralis major myocutaneous flap (esPMMF) and a conventional pectoralis major myocutaneous flap (PMMF). Methods: The study enrolled 91 patients with primary oral and oropharyngeal squamous cell carcinoma (SCC) who underwent radical resection followed by reconstruction of the defect using either an esPMMF via the anterior axillary line or a PMMF. The pedicle lengths of the esPMMF and PMMF were 22‐28 and 18‐22 cm, respectively. The esPMMF and PMMF had skin paddle dimensions of 5 × 8 to 7 × 14 cm and 6 × 7 to 8 × 17 cm, respectively. Results: The esPMMF pedicle was longer than that of the PMMF. The range of shoulder abduction was significantly greater in the esPMMF group and the donor‐site aesthetic results were better. Conclusion: The esPMMF has a longer pedicle flap, enables a greater range of shoulder abduction, and has a better aesthetic result than the conventional technique. [ABSTRACT FROM AUTHOR]

Background Donor site morbidity of pectoralis major pedicled flap (PMPF) is scarcely studied. Methods A cross-sectional study on patients who underwent reconstructive surgery with a PMPF at least 6 months before was performed. Patients with a similar type neck dissection on both sides and PMPF on one side ( n = 9) were assigned to group 1; patients with neck dissection and PMPF ( n = 26) were assigned to group 2; and neck dissection only ( n = 47) were assigned to group 3. All 3 groups filled out a shoulder disability questionnaire and underwent shoulder function tests. Pain of the shoulder was rated on a visual analog scale (VAS). Patients were also asked if they had experienced stiffness of the shoulder during the previous week. Range of motion (ROM) of the shoulder was examined by one single examiner using an inclinometer, in accord with a standardized protocol. Radical neck dissection (RND), modified radical neck dissection (MRND), and selective neck dissection (SND) sides were separately analyzed. Results In group 2, shoulder morbidity was experienced more often ( p = .065) than in group 3, particularly at the sides where an SND was performed ( p = .010). Significant differences in prevalence of shoulder stiffness between PMPF and neck dissection sides and neck dissection only sides were found in the RND ( p = .001) and MRND ( p = .004) groups, but not in the SND group. A lower ROM of abduction ( p = .026) was found in group 2 as compared to group 3. Conclusion Patients frequently have additional shoulder morbidity after PMPF harvest, particularly after SND. PMPF harvest adds to impairment of abduction. © 2016 Wiley Periodicals, Inc. Head Neck 38:1221-1228, 2016 [ABSTRACT FROM AUTHOR]

Background The role of pectoralis major muscle flap (PMMF) in reducing the rate of pharyngocutaneous fistula after salvage total laryngectomy has not been clearly established. The purpose of this study was to evaluate the impact of PMMF in reducing pharyngocutaneous fistula rates after total laryngectomy. Methods The analyzed intervention was the use of a PMMF after total laryngectomy. Results Pharyngocutaneous fistula occurred in 230 cases (global incidence, 30.9%). In the group of patients who underwent PMMFs, there were 49 cases of pharyngocutaneous fistula, compared with 181 cases in the control group. There was a 22% decreased risk of pharyngocutaneous fistula incidence in the PMMF group ( p < .001). Patients who underwent a PMMF had lower risk of pharyngocutaneous fistula compared with the control group ( p = .008). There were no changes when only patients who underwent total laryngectomy ( p < .001) and those who underwent total pharyngolaryngectomy ( p = .007) were separately assessed. Conclusion Prophylactic use of PMMF decreases the incidence of pharyngocutaneous fistula after salvage total laryngectomy. © 2015 Wiley Periodicals, Inc. Head Neck 38: E2317-E2321, 2016 [ABSTRACT FROM AUTHOR]

Background The purpose of this study was to compare the use of an extended vertical lower trapezius island myocutaneous flap (TIMF) and a pectoralis major myocutaneous flap (PMMF). Methods A total of 39 patients with advanced recurrent oral and oropharyngeal squamous cell carcinoma (SCC) underwent salvage surgery followed by placement of either an extended lower vertical TIMF or PMMF for reconstruction. Twenty-one patients received extended lower vertical TIMFs, whereas 18 received PMMFs. Results The pedicle length of the TIMF was longer than that of the PMMF, and the skin paddle of the TIMF was both wider and longer than the PMMF. No major complication developed in any of the patients. The TIMF group experienced a lower rate of minor flap failure than did the PMMF group. Conclusion Use of an extended vertical lower TIMF, which has a longer pedicle flap and a larger skin paddle than a PMMF, is optimal for reconstruction of major defects. © 2015 Wiley Periodicals, Inc. Head Neck 38: E159-E164, 2016 [ABSTRACT FROM AUTHOR]

Background. The effect of pectoralis major flap (PMF) harvest on shoulder function, allowing for the effects of neck dissection, has not previously been objectively measured. Methods. Twenty-two patients who underwent PMF reconstruction were studied. The control group comprised 35 patients with neck dissection (without PMF). Neck dissections in both groups were classified into 3 grades; grade 1: no neck dissection/selective neck dissection; grade 2: modified radical neck dissection; grade 3: radical neck dissection/extended radical neck dissection. Objective shoulder assessments were carried out using Constant score. Results. Constant score deteriorated with grade of neck dissection (p < .005). The median Constant score for PMF group and neck dissection only group were 82 and 90, respectively (p = .40). Subgroup analysis within neck dissection grade did not show any significant difference, but the effect of PMF was noted to be greatest in grade 2 patients (p = .064). Conclusions. There is minimal or low shoulder morbidity, additional to neck dissection, caused by PMF reconstruction in head and neck surgery. © 2009 Wiley Periodicals, Inc. Head Neck, 2009 [ABSTRACT FROM AUTHOR]

Background We report the 10th case in the English-language literature describing clavicular osteomyelitis that presented after radical treatment for laryngeal carcinoma and discuss the pertinent diagnostic and therapeutic measures. It presented a diagnostic dilemma. The differential diagnosis included tumor recurrence, metastatic bone disease, and postradiotherapy complications. Methods and Results A 45-year-old man who was a heavy smoker and known drug abuser presented with acute airway compromise and was diagnosed with squamous cell carcinoma involving the glottis and subglottis. Total laryngectomy, total thyroidectomy, and bilateral neck dissection were performed, and the patient underwent chemoradiotherapy. On follow-up 1 year later, the patient was seen with left stomal dehiscence and a large area of cellulitis extending across the left clavicle and down to the axilla. At surgery, a large anterior chest wall abscess was found. Biopsy showed no evidence of tumor. After aggressive treatment, the patient remains disease free. Conclusions This condition is rarely encountered after major head and neck surgery. Aggressive surgical debridement and antibiotic therapy remains the mainstay of treatment. Prompt diagnosis and treatment are mandatory due to the potential life-threatening complications associated with the condition. Bony resection will aid in adequate flap placement. © 2008 Wiley Periodicals, Inc. Head Neck, 2008 [ABSTRACT FROM AUTHOR]