Jan 08, 2016 pedicled flaps in head and neck surgery 1. In india head and neck cancer patients usually present in the advanced stage making pmmc flap a viable option for reconstruction. This elearning course provides a step by step approach. Pedicled flaps in head and neck surgery slideshare. Surgical treatment of oral cavity cancer a free powerpoint ppt presentation displayed as a flash slide show on id. A versatile flap for reconstruction in the head and neck. The muscle lying over the clavicle will produce a prominent bulge.
In 1979, ariyan was the first to describe the use of the pmmc flap in head and neck reconstruction. The pectoralis major myocutaneous flap in head and neck. After harvesting the myocutaneous flap, the whole pectoralis major muscle together with the skin paddle is turned upwards to the head and neck region. The pectoralis major flap comprises the pectoralis major muscle, with or without overlying skin, and may include the under lying ribs. Done in an appropriate manner as outlined here, the extended flap increases the versatility of pectoralis major myocutaneous flap in head and neck reconstruction. The pectoralis major myocutaneous flap pmmf is useful in head and neck reconstruction. These instruments were applied to the hemiglossectomy with bilateral neck dissection and immediate reconstruction with a pectoralis major myocutaneous flap for a 64yearold woman with squamous cell carcinoma of the right tongue stage t4an2bm0. The pedicled pectoralis major myocutaneous pmmc flap is versatile, and is widely used for the treatment of surgical defects following oral. Sp represents the initial proposed skin paddle, whereas sp. Functional pectoralis minor myocutaneous flap transplantation. A modified pectoralis major myocutaneous flap technique with. Since its introduction by ariyan in 1979, the pectoralis major myocutaneous flap pmmf has been used as a workhorse flap for the reconstruction of the. Pdf pectoralis major myocutaneous flap for head and neck. Pectoralis major myocutaneous flap for head and neck defects in the era of free flaps.
Complications of the pectoralis major osteomyocutaneous flap. An immediate reconstructive surgery with a pectoralis major. The pectoralis major myocutaneous flap pmmf is useful in head and neck. Pectoralis major muscle an overview sciencedirect topics. Exposure of pectoralis major muscle the skin paddle is tacked to the underlying pectoralis major muscle with a few sutures so as to minimise the risk of shearing injury to the myocutaneous per forators the skin and breast tissue above the skin paddle is then widely elevated from the pectoralis major muscle with diathermy up to the clavicle 15. Myocutaneous definition of myocutaneous by medical dictionary.
Complications of the pectoralis major myocutaneous flap in t. Reconstruction of the oral cavity michael underbrink, m. Since its introduction by ariyan in 1979, the pectoralis major myocutaneous flap pmmf has been used as a workhorse flap for the reconstruction of the head and neck defects in the following three. Extended pectoralis major myocutaneous flap in head and. Although the pectoralis major muscle as a basis for a variety of flaps is still a workhorse for head and neck reconstruction1 and a flap of choice for anterior chest wall reconstruction,2 coverage of dorsal upper chest wall defects including the axilla are hardly described. The pectoralis minor myocutaneous flap was placed in the defective thenar muscle along the direction of its fibers, and the surgical wound was closed with a dexon suture from the starting point of the transverse carpal ligament to the radial first metacarpal. Its application in the head and neck region, however, was not reported until ariyans publication in 1979. The extended pectoralis major flap for reconstruction of the. Reliability of the pectoralis major myocutaneous flap in reconstructive oral cancer surgery in developing countries.
Line a represents the lateral incision, the first one made in the procedure. Pectoralis major flap vula university of cape town. No bone grafts, omentum flaps or skin grafts have been needed in more than 20 patients. The pectoralis major myocutaneous flap for reconstruction was first described in 1968. The pectoralis major myocutaneous flap offers a very important reconstructive option in contemporary head and neck surgery. Pectoralis major myocutaneous flap and myofascial flap iowa. Free pectoral skin flap in the rat based on the long thoracic. Anatomy of pectoralis major the pectoralis major is a flat triangular fan shaped muscle lying on the anterior and superior aspect of the chest wall. Jan 12, 2014 sternal dehiscence after open heart surgery and reconstruction with pectoralis flap. Pmf, including the entire pectoralis major muscle, was routinely used for amt reconstruction. Pectoralis major flap british association of oral and.
Pectoralis major myocutaneous flap pocket dentistry. Unilateral pyramidotomy of the corticospinal tract in rats for. Improve your surgical skills by following this elearning module. After stephan ariyan first described its use for head and neck reconstruction in 1979, it has become tremendously popular and has revolutionised head and neck cancer surgery.
The pectoralis major flap johan fagan the pectoralis major flap comprises the pectoralis major muscle, with or without overlying skin, and may include the underlying ribs. Pectoralis major myocutaneous flap technique for male patients. Dedivitis ra 2017 the pectoralis major musculocutaneous flap in head and neck cancer reconstruction lob surg, 2017 doi. Although freetissue transfer is often preferred, the benefits of the pmmf should not be. A pectoralis major pedicled flap maintains its own blood supply and is one of the. Pectoralis major myocutaneous flap for head and neck defects in.
The pectoralis major myocutaneous flap in mediastinal. Pectoralis major muscle flaps for closure of sternal defects. Pectoralis major myocutaneous flap and myofascial flap see also. The extent of coverage and the reach of the flap are dependent on the anatomy of the patient, modifications of the standard techniques of. Although the use of micro vascular free flaps is a reliable procedure, the pectoralis major myocutaneous flap is still applicable for selected. Pectoralis major myocutaneous flap flashcards quizlet. Pectoralis major myocutaneous flap for head and neck defects. Jun 04, 2016 one of the earliest methods described involved development of the pectoralis major pm myocutaneous flap, which was first used by dr. The pectoralis major myocutaneous flap pmmf remains a useful flap for head and neck reconstruction. Ariyan7,8,9 introduced the pectoralis major myocutaneous flap to head and neck surgery. Pectoralis major myocutaneous flap is a versatile flap and used in head and neck reconstruction for ablative tumor surgery.
Learn about the pectoralis major flap, an online 3dvideobased course, accredited by the royal college of surgeons of england. The pectoralis major myocutaneous flap pocket dentistry. Novel method to repair tracheal defect by pectoralis major. Pectoralis major myocutaneous flap in head and neck reconstruction. Pectoralis major myocutaneous flap for head and neck.
It has an axial blood supply and is based superiorly on the pectoral branch of the thoracoacromial artery. First described in 1947 but not used for head and neck construction until 1979. Pectoralis major myocutaneous flap in head and neck surgery. A reliable and simple technique involving the use of pectoralis major muscle flaps is described for the closure of sternal and costal cartilage defects caused by debridement for chronic osteomyelitis following median sternotomy. The pectoralis major flap comprises the pectoralis major muscle. Myocutaneous flaps commonest reconstructive option for head and neck defects include. Pectoralis major myocutaneous flap reconstruction of the. Mar 02, 2015 pectoralis major myocutaneous flap in head and neck reconstruction 1.
The pectoralis major myocutaneous pmmc flap has been used as a versatile and reliable flap since its first description by ariyan in 1979. A harvesting a pedicled pectoralis major myocutaneous pmmc flap with a 9x7. Department of otorhinolaryngology, head and neck surgery ent. Department signed memorandums of understanding for academic collaboration with three mainland china institutions, namely, the otolaryngology hospital of the first affiliated hospital of sun yatsen university, guangzhou. The pectoralis major myocutaneous flap pmmc flap represents a landmark in the development of head and neck reconstructive surgery. The first published reports of the use of a pectoralis major myocutaneous flap pmf in head and neck reconstruction was that of ariyan 1979a and b. A free powerpoint ppt presentation displayed as a flash slide show on id. Ten patients with squamous cell carcinoma of the floor of the mouth who had undergone segmental glossectomy and mandibulectomy, radical uni or bilateral cervical lymphadenectomy, and immediate reconstruction with the. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising.
Introduction difficult challenge complex anatomy and function goals restore preoperative. Extended pectoralis major myocutaneous flap in head and neck. However, limiting the skin paddle to within the surface area of the pectoralis major muscle may occasionally restrict the ability to reconstruct large, high or complex defects. It is plausible that some of the complications reported previously with the pectoralis major flap 8,9 might have been avoided by utilizing the extended flap. What is a pectoralis major myocutaneous flap used for. The reliability and versatility of this flap were subsequently confirmed by many other reports. The reliability of pectoralis major myocutaneous flap in head. Pectoralis major myocutaneous flap is a soft tissue reconstructive surgical procedure that provides oral lining and facial cover of soft tissue defects. The pectorals major myocutaneous flap is not only a versatile flap but also a very reliable and robust one for single stage immediate head and neck reconstruction 16. Jun 04, 2016 the pectoralis major myocutaneous pmmc flap has always been considered the workhorse flap for oral, head, and neck reconstruction. Case example of pectoralis myocutaneous flap general considerations.
A prospective study of 220 consecutive pectoralis major myocutaneous flaps used for oral cavity reconstruction from march of 1990 to february of 1991 showed that 89 patients 40. Ppt surgical treatment of oral cavity cancer powerpoint. Free and regional flaps for head and neck reconstruction. Pmmc flap was used to cover mucosal defect in 84 patients, skin defects in 10 patient and both in 6 patients bipaddled. Flap territory the pectoralis major myocutaneous flap pmmf is useful in head and neck reconstruction.
Indications the pectoralis major myocutaneous flap and myofascial flap variation are utilized in a large variety of head and neck reconstructive procedures that can include coverage of mucosal andor cutaneous defects. Pdf pectoralis major myocutaneous flap in head and neck. In certain cases when infiltration of a tumor or trauma or previous damage to the vascular supply precludes the use of. Bthe pectoralis minor muscle was divided around the lateral thoracic vessels to enable the supply of blood to the pmmc flap. The extent of coverage and the reach of the flap are dependent on the anatomy of the patient but the upper limits are generally considered the zygomatic arch externally and the tonsillar bed internally. The pectoralis major muscle is composed of the clavicular and sternocostal heads. Sternal dehiscence after open heart surgery and reconstruction with pectoralis flap. We experienced only one failure of the flap in a patient in whom the right pmf had been previously used in the head and neck area and who underwent ligation of the left innominate vein during the procedure. Usually include potential for pectoralis major myocutaneous flap pmc or other reconstructive options in the event the tumor extent is found to be greater than initially determined. This is the most commonly used pedicled flap for the reconstruction of tumor adn traumarelated defects fo the oral and maxillofacial region. Pdf the pedicled pectoralis major myocutaneous pmmc flap is versatile, and is widely used for the treatment of surgical defects following oral. The analysis of the complications of the pectoralis major osteomyocutaneous flaps used for head and neck reconstruction and how to prevent them is the subject of this report. Pectoralis major myocutaneous flap in head and neck reconstruction by dr. The surface markings of the vascular pedicle were made by drawing a line from the ipsilateral.
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