Two modifications of pectoralis major myocutaneous flap (PMMF)

Abstract

Pectoralis major myocutaneous flap is the most commonly used versatile flap in head and neck reconstructive surgery. The use of entirely tubed pcctoralis major myocutaneous flap for reconstruction of the hypophnrynx following total laryngectomy and total pharyngectomy has a disadvantage of bulkincss of the flap and poor postoperative deglutition. One-stage reconstruction of the entire hypophnrynx utilizing a combination of pcctoralis major myocutaneous flap and dermal graft minimizes bulkiness, thus achieving satisfactory to excellent functional results. The operation has been performed on four pn- tients with excellent deglutition. The pcctoralis major myocutaneous flap is utilized to reconstruct the anterior and lateral walls of the hypophnrynx, the dermal graft for the posterior wall as far superior ns the vault of the nasopharynx. The operative procedure is described. Pectornlis major myocutaneous flap usually provides enough length to reach the distant site of the surgical defect. On occasion, however, additional length is desirable to avoid tension along the suture line. This becomes apparent when a random portion of elevated pcctoralis major myocutaneous flap presents questionable viability which may require further trimming. Resection of the medial half or the clavicle can provide additional length of this flap by 2 cm to 2.5 cm. © The American Laryngological, Rhinological & Otological Society, Inc.