Clinical outcome after pedicled segmental pectoralis major island flaps for head and neck reconstruction.

The pectoralis major is reliable for reconstruction of large defects in the head and neck area. In 2001, we introduced a muscle-sparing technique with preservation of the clavicular part of the muscle. So far, we did not report on its reliability and clinical outcome at the receptor site.Fifty-four pedicled segmental pectoralis major island flaps were used in 53 patients, from 2001 through 2006. As outcome measures, we studied the overall rate of complications, the rate of major complications, and the final outcome at the receptor sites. We differentiated for the types of complications and assessed operation indication (primary vs. salvage procedure), site of reconstruction, previous radiotherapy, and completeness of tumor excision as possible risk factors for complications. We compared our findings to those of a meta-analysis of 16 other studies.Complications at the receptor site were observed after 21 of the 54 operations (0.39). Eleven of these cases (0.52) required repeated surgery that was successful in 8 cases (0.72). Conservative treatment was successful in 8 cases (0.80). Final outcome was successful in 49 of the 54 operations (0.91). Previous radiotherapy was a significant risk factor for persisting complications. Salvage procedures were a significant risk factor for developing clinical fistulas and the risk of partial flap loss was significantly correlated with nonhypopharyngeal reconstructions. Our results were comparable with those found in the meta-analysis.Our muscle-sparing technique proved to be reliable with clinical results comparable with conventional techniques in addition to function preservation at the donor site.

Anatomy of the vascular pedicle of the internal mammary artery perforator (IMAP) flap as applied for head and neck reconstruction.

INTRODUCTION: The vascular pedicle of the internal mammary artery perforator (IMAP) flap and its enhancement by inclusion of the internal mammary vessels up to the level of the first rib have not been systematically assessed anatomically, to date. This study assesses these features of this pedicle in light of the flap's application in head and neck reconstruction. MATERIAL AND METHODS: The length of the dominant perforator and the enhanced vascular pedicle of the IMAP flap were measured in 27 fresh cadaveric hemi-thoraxes. RESULTS: In 18 out of 27 cadaveric cases (0.67) the second perforator was dominant. The mean length of the 27 dominant perforators was 47 mm (range: 30-66 mm). By enhancement up to the level of the first rib, the mean length of the vascular pedicle could be doubled to 92 mm when based on the second perforator (0.67). In the five cases (0.19), where the third perforator was dominant, the mean length of the enhanced pedicle was 104 mm, whereas it was 61 mm in the four cases (0.15) where the first perforator was dominant. CONCLUSION: This is the first study that assessed the enhanced length of the vascular pedicle of the IMAP flap. Our results show that the mean length of the dominant second perforator may be doubled by such enhancement and that the arc of rotation to the head and neck region may, then, be doubled again. Hereby, even high-located defects in the head and neck region can be reached. This provides a better understanding of the feasibility of the pedicled IMAP flap in head and neck reconstruction.