Oh Jeongseok, Ahn Hee Chang, Youn Seungki, Tae Kyung
From the Departments of Plastic and Reconstructive Surgery and.
Otolaryngology, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Korea.
Ann Plast Surg. 2018 Aug;81(2):186-191. doi: 10.1097/SAP.0000000000001453.
The pectoralis major musculocutaneous (PMMC) flap is a classic flap for head and neck reconstruction, relatively unpopular with the advancement of microsurgery and free flaps. The classic parasternal paddle design provided a thick flap with a small rotation arch leaving objectionable scarring. Our new symmetric midsternal design overcomes these problems.
Chart review was done from the years 2000 to 2017. Flap skin paddle was placed symmetrically on both sides of the midsternal line. The pectoralis major (PM) muscle and aponeurosis were attached in the lateral half of the skin paddle. Most of PM muscle was elevated with the thoracoacromial vessel and dissected to the main trunk, where the PM muscle was cut and used for bulk. The flap was transferred to the neck and lower mandibular area. The flap was inset either supraclavicularly, covering the anterior neck, or subclavicularly, for intraoral/maxillary defects.
Eight patients underwent head and neck reconstruction using the new design of PMMC flap between the years 2000 and 2017. The etiologies of the defect were radiation necrosis in 3 patients, repair of cutaneous fistulas in 3, recurrent hypopharyngeal cancer in 1, and recurrent tongue cancer in 1 patient. There were no flap losses or major complications.
With the advancement of free-flap techniques, the classic flaps have become less popular. Our new design supplements the PMMC flap by providing a thin pliable flap with a long pedicle and rotation arc, allowing a combination of different types of flaps to cover composite head and neck defects, especially in cases that lack a reliable recipient vessel due to radiation.
胸大肌肌皮瓣（PMMC瓣）是头颈部重建的经典皮瓣，随着显微外科和游离皮瓣技术的发展，其应用相对减少。传统的胸骨旁皮瓣设计提供的皮瓣较厚，但旋转弧度小，会留下明显瘢痕。我们新的对称胸骨中线设计克服了这些问题。
回顾2000年至2017年的病历。皮瓣皮岛对称置于胸骨中线两侧。胸大肌（PM）及其腱膜附着于皮岛外侧半部分。大部分胸大肌随胸肩峰血管掀起并解剖至主干，在此处切断胸大肌用于填充。将皮瓣转移至颈部和下颌下区域。皮瓣可在锁骨上植入，覆盖前颈部，或在锁骨下植入，用于修复口腔内/上颌缺损。
2000年至2017年间，8例患者采用新设计的胸大肌肌皮瓣进行头颈部重建。缺损病因包括3例放射性坏死、3例皮肤瘘修复、1例下咽癌复发和1例舌癌复发。未出现皮瓣坏死或严重并发症。
随着游离皮瓣技术的发展，经典皮瓣的应用越来越少。我们的新设计通过提供薄而柔韧、蒂长且旋转弧度大的胸大肌肌皮瓣对其进行了补充，可联合不同类型皮瓣覆盖头颈部复合缺损，尤其适用于因放疗导致缺乏可靠受区血管的病例。
