title: Extending the Arc of Rotation of the Pectoralis Major Myocutaneous Flap for Orofacial Reconstruction via a Modified Subclavicular Route Through the Clavipectoral Fascia.
abstract: OBJECTIVE
  Drawbacks of the conventional supraclavicular overlay of the pectoralis major myocutaneous flap (PMMF) include the resultant unesthetic cervical bulge and the limited cephalad extension that limits its use to mandibular or cervical defects. This study discusses the technique and comparative advantages of a more esthetic subclavicular route through the clavipectoral fascia that allows an increased arc of rotation to reconstruct orofacial defects.
  
  
  METHODS
  Patients with orofacial defects that were reconstructed with a PMMF through the modified subclavicular route were included in this retrospective cohort study, which aimed to compare the gain in extension accorded through the modified subclavicular tunnel over an initial conventional supraclavicular overlay. Outcome variables included the dimension of each skin paddle and the cross-sectional area of each flap. Other variables, such as age and gender, also were investigated. Complications that arose from this technique were statistically compared with these variables and with those from previously reported studies. All data analyses were performed using Pearson χ2and correlation tests.
  
  
  RESULTS
  Twelve patients (7 women and 5 men) who underwent a primary reconstruction with the PMMF during a 1-year period from November 2010 to November 2011 were selected for this study. All 12 flaps survived; 3 developed minor postoperative complications that resolved within the 3-month review period. A PMMF with an average dimension of 12.75 × 6.0 × 3.725 cm and cross-sectional area of 20.65 cm2could pass through this modified tunnel, achieving an average gain in extension of 3.2 cm that enabled the reconstruction of defects up to and above the level of the oral commissure. Apart from skin paddle dimension, all other variables were not found to be statistically related to the extension accorded by the modified route. Complications that occurred appeared to be related only to the cross-sectional area of the flap.
  
  
  CONCLUSIONS
  The increased cephalad extension afforded by this modified subclavicular route through the clavipectoral fascia permitted the reconstruction of orofacial defects that would otherwise have required free vascularized grafts with microvascular surgery and avoided the unesthetic cervical bulge from conventional supraclavicular overlays of the PMMF.
authors.affiliation: Consultant, Dental Surgery, Oral and Maxillofacial Surgery, Khoo Teck Puat Hospital, Singapore, China.
authors.forename: Eugene Hze-Khoong
authors.initials: EH
authors.lastname: Poh
authors.affiliation: Professor, Department of Oral Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University, Shanghai, China. Electronic address: maxilla@sina.com.
authors.forename: Li-Qun
authors.initials: LQ
authors.lastname: Xu
authors.affiliation: Consultant, Department of Oral Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Xue-Lai
authors.initials: XL
authors.lastname: Yin
authors.affiliation: Consultant, Department of Oral Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Shu-Kun
authors.initials: SK
authors.lastname: Shen
mesh_terms: D000328:Adult; D000368:Aged; D005153:Facial Neoplasms / Q000601:surgery*; D000071938:Fasciotomy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery*; D064827:Myocutaneous Flap / Q000601:surgery*; D010369:Pectoralis Muscles / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies