title: The changing role of pectoralis major flap in head and neck reconstruction.
abstract: Although pectoralis major flap (PM flap) has been used as the workhorse flap in head and neck reconstruction, its use in head and neck defects seems to fall out of favour in the era of free tissue transfer. The aim of this review is to find out the role of PM flap in modern head and neck surgery. Medical records of patients who underwent PM flap reconstruction for head and neck defect in our division were reviewed. The age, gender, flap type, indication and complication rate were described. Between January 1998 and December 2008, 202 PM flaps were used for head and neck reconstruction in 192 patients. In the early study period (1998-June 2003), out of the 119 PM flap reconstructions, 106 (89%) were performed for immediate reconstruction after resection of head and neck tumour, while 10 (8%) were performed as salvage procedures for complication after tumour resection e.g. failure of free flap, pharyngocutaneous fistula. In the late study period (July 2003-2008), out of the 83 PM flap reconstructions, 58 (70%) were performed for immediate reconstruction, while 24 (29%) were performed as salvage procedures. For immediate reconstruction after tumour extirpation, 51 flaps (48%) were performed for reconstruction of the tongue in the early study period, while only 14 (24%) were performed in the late study period. The number of PM flap used for immediate reconstruction for other head and neck defects remained relatively static throughout the two study periods. Over the study period, there were 10 (5%) cases of partial flap necrosis and 2 (1%) total flap loss, making the overall flap necrosis rate 6%. In the era of free tissue transfer, the role of PM flap in head and neck surgery has shifted from immediate reconstruction to salvage operation. However, PM flap still has an unique role in the repair of certain head and neck defects.
authors.affiliation: Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China. lawrencehlliu@gmail.com
authors.forename: Hin-Lun
authors.initials: HL
authors.lastname: Liu
authors.forename: Jimmy Yu-Wai
authors.initials: JY
authors.lastname: Chan
authors.forename: William Ignace
authors.initials: WI
authors.lastname: Wei
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006257:Head / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000601:surgery; D010369:Pectoralis Muscles / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000379:methods*; D016038:Skin Transplantation; D013524:Surgical Flaps; D016896:Treatment Outcome
references.citation: Plast Reconstr Surg. 1979 Jan;63(1):73-81
references.pmid: 372988
references.citation: Head Neck. 1997 Aug;19(5):412-8
references.pmid: 9243269
references.citation: Plast Reconstr Surg. 1996 Jul;98(1):31-7
references.pmid: 8657786
references.citation: Ann Plast Surg. 2005 Oct;55(4):384-8
references.pmid: 16186704
references.citation: Ann Plast Surg. 1990 Aug;25(2):93-7
references.pmid: 2396828
references.citation: Clin Otolaryngol. 2007 Aug;32(4):275-82
references.pmid: 17651269
references.citation: Otolaryngol Head Neck Surg. 2003 Mar;128(3):412-8
references.pmid: 12646846
references.citation: Head Neck. 2007 Aug;29(8):758-64
references.pmid: 17274050