Introduction of the Janus flap. A modified pectoralis major myocutaneous flap for cervical esophageal and pharyngeal reconstruction.

The pectoralis major myocutaneous flap (PMMF), with its design and modified applications, is a versatile and reliable method for the reconstruction of large defects that result from surgical ablation or trauma. Defects of the cervical esophagus (two cases) and pharynx (one case) were repaired. In three cases, a technique variation of "banked skin" (the Janus flap) was used to repair through-and-through defects that required two epithelial surfaces. In two cases, the PMMF was harvested after a previous ipsilateral deltopectoral flap. The flap survived preoperative or postoperative radiation in all of the cases. Pharyngoesophageal function was restored in an average of 19 days, with the exception of one case of persistent carcinoma (63 days). There were no major complications or flap failures.