Although slightly less reliable than the pectoralis major flap, it is a dependable source of large amounts of tissue for head and neck reconstruction. I was into weight training and bodybuilding from the age of, blessed with a natural muscular build i made good progress in my training without the use of anabolic steroids or growth hormones. The pectoralis major myocutaneous flap pmmc flap represents a landmark in the development of head and neck reconstructive surgery. The pectoralis major from latin pectus, meaning breast is a thick, fanshaped muscle, situated at the chest of the human body. Between october 1994 and march 1996, 14 consecutive patients with a wound dehiscence after median sternotomy for cardiac surgery were treated with pectoralis major myocutaneous advancement flaps. Pectoralis major myocutaneous flap in head and neck reconstruction by dr. The treatment of sternal wound complications is controversial. Introduction although historically a rare injury, pectoralis major tendon rupture is becoming more common. Simple pectoralis major myocutaneous advancement flaps for. There are two such muscles on each side of the sternum breastbone in the human body.
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. Pectoralis minor questions and study guide quizlet. Injuries of the pectoralis major muscle can include a rupture in the insertion of the muscle, on the superior anterior portion of the humerus. The first description of the pectoralis major flap for head and neck reconstruction was by ayrian in 1978. 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. Myocutaneous flap an overview sciencedirect topics. Pdf the role of the pectoralis major myocutaneous flap pmmf in head and neck.
The pectoralis major myocutaneous flap is a mathes and nahai type v muscle flap with one dominant pedicle pectoral branch of the thoracoacromial and secondary segmental pedicles internal mammary perforators. Pectoralis major myocutaneous flap is a soft tissue reconstructive surgical procedure that provides oral lining and facial cover of soft tissue defects. The pectoralis major muscle is a strong, fanshaped muscle of the shoulder joint. The pectoralis major myocutaneous flap pmmf is a commonly used flap in reconstructive head and. After stephan ariyan first described its use for head and neck reconstruction in 1979, it has become tremendously popular. This elearning course provides a step by step approach. Contemporary role of pectoralis major regional flaps in head and. Objective to examine our outcomes with skin paddle survival using pectoralis myocutaneous flaps in reconstruction of the head and neck. Secondary omental and pectoralis major double flap. Use of pectoralis major myocutaneous flap for resurfacing the.
This was to enable the obliteration of dead space between the. On the cranial side, half of the clavicular attachment was divided, preserving continuity. Possibly, full mobilization of the pectoralis major mus. The pectoralis major myocutaneous flaps described by ariyan and baek are a hybrid of conleys laterally based deltopectoral flap and huestons. Case report open access doublepaddled pectoralis major. Anatomy and functions of the major pectoralis muscle kenhub. Blood supply of pectoralis major flap figures 2, 3 the pectoralis major flap is an axial flap and is based primarily on the pectoral branch of the thoracoacromial artery and the thoracoacromial artery is a branch of the axillary artery, itself a continuation of the subclavian artery. This was to enable the obliteration of dead space between the mediastinum and the flaps. Pectoralis major myocutaneous flap and myofascial flap see also.
Experiences and challenges in a developing country. Pectoralis major flap british association of oral and. Evaluation of the pectoralis major flap for reconstructive. Jan 12, 2014 sternal dehiscence after open heart surgery and reconstruction with pectoralis flap. Its innervated by both medial and lateral pectoral nerves. Case example of pectoralis myocutaneous flap general considerations. The bilateral pectoralis major muscle was fully mobilized following detachment of the costal insertion, without resecting the humeral insertion, then rotated and sutured together without tension on the midline in a ventral of the omentum flap 26. The pectoralis major myocutaneous flap pmmf, considered the workhorse in head and neck surgery, represents one such pedicled flap. He described raising a medially based fasciocutaneous flap from the shoulder skin, which was then tubed and used for staged nasal reconstruction. Mar 02, 2015 pectoralis major myocutaneous flap in head and neck reconstruction 1. Pectoralis major muscle an overview sciencedirect topics. Nowadays, free flaps are more common due to improved microsurgical techniques, but in several cases the pmmf still has its advantages, including its. Pharyngeal peconstruction surgery by konstantinos apostolopoulos. It has an axial blood supply and is based superiorly on the pectoral branch of the thoracoacromial artery.
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 origins of deltopectoral flaps and the pectoralis. Most physicians do not have experience in surgical management of pectoralis major tears. The pectoralis major myocutaneous pmmc flap has always been considered the workhorse flap for oral, head, and neck reconstruction.
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. Pectoralis major myocutaneous pmmc flap, based on the thoracoacromial artery, whose first. The pectoralis major myocutaneous flap in head and neck. In both exercises, the individual lies supine on a bench with feet flat on the ground. Gaps in the field of literature are also addressed. The pectoralis major muscle is composed of the clavicular and sternocostal heads. It decisively shapes the surface anatomy of the breast. Unlike microvascular free flap, 5th rib osteo pectoralis major myocutaneous flap reconstruction is quick with an average time of 1 h to raise and place the flap. It is our practice to combine early aggressive debridement, a modified robicsek sternal closure, and bilateral pectoralis major advancement flaps with or without closed irrigation in a single procedure.
This article is intended to assist them by outlining a diag. The pectoralis major myocutaneous flap pmmf is a commonly used flap for reconstructive head and neck surgery. After harvesting the myocutaneous flap, the whole pectoralis major muscle together with the skin paddle is turned upwards to the head and neck region. Flaps and reconstructive surgery by fuchan wei and samir. The flat barbell bench press and the flat dumbbell bench press both involve utilizing the pectoralis major muscle. With coverage of nearly twice the number of flaps as the previous edition, flaps and reconstructive surgery, 2nd edition provides trainees and practicing surgeons alike with the detailed, expert knowledge required to ensure optimal outcomes. Furthermore it participates in forming the anterior wall of the axilla.
Summary pectoralis major myocutaneous flap is a soft tissue reconstructive surgical procedure that provides oral lining and facial cover of soft. Pectoralis major article about pectoralis major by the free. The pectoralis major myocutaneous flaps described by ariyan and baek are a hybrid of conleys laterally based deltopectoral flap and huestons inclusion of the pectoralis major muscle in the skin flap. This article describes a technique for soft tissue coverage in an infected or irradiated area after resection using a split pectoralis major rotational muscle flap. The surface of the flap was covered by squamous epithelium in 1 month. Historical evolution basically divided in 3 phases 1. Download as an information leaflet pdf pectoralis major flap. Pectoralis major myocutaneous flap in head and neck reconstruction 1. The flap remained healthy during and after radiotherapy.
Miguel jagessar and michael gray, academy of sport and leisure, the university of trinidad and tobago, trinidad, west indies. It is very useful in the head and neck, and can inter alia. In 1979, ariyan was the first to describe the use of the pmmc flap in head and neck reconstruction. Download file pdf pectoralis major myocutaneous flap in head and neck reconstruction a color atlas pectoralis major myocutaneous flap in head and neck reconstruction a color atlas right here, we have countless book pectoralis major myocutaneous flap in head and neck reconstruction a color atlas and collections to check out. To view the pectoralis major, you must cut away a large amount of superficial muscle and connective tissue. It can be used as a musculocutaneous or even osteomusculocutaneous flap although this is not usually necessary. Improve your surgical skills by following this elearning module. It is an axial pattern flap, based off and following a named vessel. Department of otorhinolaryngology, head and neck surgery ent. While it is possible to do just by wiggling around the blunt probe and using your fingers, you should be careful not to cut or damage any muscles under the pectoralis. This article seeks to determine optimum bodyhand position and the best exercises for development of the pectoralis major. No bone grafts, omentum flaps or skin grafts have been needed in more than 20 patients.
The causes of this injury involve intensive weightlifting, such as the bench press. Pectoralis major myocutaneous flap local and regional. The pectoralis major myocutaneous flap has been associated with a notable incidence of distal skin. Pectoralis major flap vula university of cape town.
It is our method choice for a onestage reconstruction in head and neck. The first published reports of the use of a pectoralis major myocutaneous flap pmf in head and neck reconstruction were those of ariyan, 1979a, ariyan, 1979b. The pectoralis myofascial flap is ideal for softtissue coverage of small to mediumsize oral cavity and pharyngeal defects. Pectoralis major myocutaneous flap in head and neck surgery. Pectoralis major turnover versus advancement flap for sternal wound reconstruction. It consists of a clavicular part and a sternal part, both converging to a flat tendon that inserts on the humerus.
After thorough sternal wound debridement, the sternal edges were contoured to create a shallow defect. The pectoralis major myocutaneous flap pmmf is a commonly used flap in reconstructive head and neck surgery, but in literature, the flap is also associated with a high incidence of complications in addition to its large bulk. The innervation is carried by the medial and lateral pectoral nerves c5t1, direct branches of the brachial plexus. There are many ways in which the pectoralis major muscle can be exercised. Pectoralis major myocutaneous flap atlas of operative oral and. Over 4 pectoralis major pictures to choose from, with no signup needed. Pdf the pectoralis major myocutaneous flap pmmf, with its design and modified. Pectoralis major myocutaneous flap in head and neck reconstruction. Sternal dehiscence after open heart surgery and reconstruction with pectoralis flap.
Regional flaps in maxillofacial and oral softtissue reconstruction. The pectoralis major myofascial flap for intraoral and. The procedure is quick and does not need a separate reconstructing team as in our case where the same surgeon did the reconstruction. Pdf pectoralis major myocutaneous flap for head and neck. It makes up the bulk of the chest muscles and lies under the breast. Optimizing development of the pectoralis major the sport. It arises from the upper margins and outer surfaces of the third. Since the description of this flap, its use quickly became widespread and within a short time it held the position as the flap of choice in head and neck reconstruction. Pectoralis major is a thick, fanshaped muscle contributing to the thoracobrachial motion. Beneath the pectoralis major is the pectoralis minor, a thin, triangular muscle.
In chest wall reconstruction, the pectoralis flap is most commonly used as a muscle advancement or rotation flap based on the thoracoacromial pedicle fig. The first published reports of the use of a pectoralis major myocutaneous flap pmf in head and neck. Pectoralis major muscle flaps for closure of sternal defects. Pectoralis major turnover versus advancement flap for. Pectoralis major allograft reconstruction shoulderdoc by. Although uncommon, pectoralis major muscles ruptures occur usually in men between the ages of 20 and 50. Pectoralis major myocutaneous flap pocket dentistry. Split pectoralis major muscle flap reconstruction after clavicular. Pectoralis major myocutaneous flap in head and neck. When treating patients with history of mold exposure always do nasal. The origins of deltopectoral flaps and the pectoralis major. Pectoralis major muscle flaps for closure of sternal.
However, in cases of flap failure or inability to harvest a free flap, pedicled flaps provide a reliable alternative with predictable results. Gomez nazim noor summary the experiences gained through the use of pectoralis major myocutaneous flap in reconstructive head and neck cancer surgery in 15 cases is presented. Its major advantages over the pectoralis myocutaneous flap are decreased bulk and improved. Latissimus dorsi flap an overview sciencedirect topics.
The purpose of the study is the evaluation of the reliability and indication of this flap in reconstructive head and neck surgery. The muscle lying over the clavicle will produce a prominent bulge. Pectoralis major myocutaneous flap and myofascial flap iowa. Mar 12, 2020 pectoralis muscle, any of the muscles that connect the front walls of the chest with the bones of the upper arm and shoulder. The aim was to evaluate the feasibility of pectoralis major myocutaneous pmmc flap in reconstruction of defects in the head and neck region. We use cookies to offer you a better experience, personalize content, tailor advertising, provide social media features, and better understand the use of our services. Learn about the pectoralis major flap, an online 3dvideobased course, accredited by the royal college of surgeons of england. The study also outlines types of other tissue required, the donor site morbidity and the technical details of the operative procedure. Reconstruction of large poststernotomy wound with bilateral vy. The pectoralis major myocutaneous flap has been associated with a notable incidence of distal skin necrosis and flap loss. Pectoralis muscle, any of the muscles that connect the front walls of the chest with the bones of the upper arm and shoulder. Hueston was the first to combine a skin flap and pectoralis major muscle for repair of the large defects of the chest wall. The pectoralis major flap in head and neck reconstruction.
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