Refinement of the pectoralis major myocutaneous flap.

The pectoralis major myocutaneous flap has become the primary reconstructive flap in head and neck surgery. We have reviewed our experience and describe some modifications of incisions for elevation of this flap which will improve cosmetic results in both male and female patients. The technique for elevation of this flap is reviewed as well as some of the problem areas including the female with a large breast and the elevation of vascularized rib with the myocutaneous flap.