title: A modified pectoralis major myocutaneous flap technique with improved vascular supply and an extended rotation arc for oral defects: A case report.
abstract: The pedicled pectoralis major myocutaneous (PMMC) flap is versatile, and is widely used for the treatment of surgical defects following oral cancer resection. Although free-tissue transfer of a vascularized free flap is often preferred, the clinical benefits of the PMMC flap should not be overlooked. The conventional technique of harvesting a PMMC flap involves a single vascular supply from the pectoral branch of the thoracoacromial artery. However, this approach compromises the distal skin island of the flap, and requires an indirect blood supply via communicating vessels, which increases the potential risk of partial distal flap necrosis. When harvesting a PMMC flap for oral and maxillofacial reconstruction, preservation of the lateral thoracic artery and use of the subclavian route are alternatives that ensure sufficient blood supply and an increased rotation arc. Such an approach enables the harvesting of a PMMC flap that can reach the entire oral cavity, including the infraorbital region, palate, middle pterygopalatine fossa and nasopharynx, with no risk of vascular insufficiency to the distal skin island. In conclusion, the technique described in the present study was able to improve the blood supply of the distal PMMC flap and increase its rotation arc.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane 693-8501, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kanno
authors.affiliation: Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane 693-8501, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Nariai
authors.affiliation: Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane 693-8501, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Tatsumi
authors.affiliation: Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane 693-8501, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Karino
authors.affiliation: Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane 693-8501, Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Yoshino
authors.affiliation: Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane 693-8501, Japan.
authors.forename: Joji
authors.initials: J
authors.lastname: Sekine
keywords: blood supply; oral cancer; pectoralis major myocutaneous flap; reconstruction; rotation arc