Limitations of the pectoralis major myocutaneous flap in head and neck cancer reconstruction.

The pectoralis major myocutaneous flap represents a major contribution to head and neck cancer reconstruction. Its advantages are improved viability, capabilities for one-stage reconstruction, and effective carotid artery protection. Limitations of the flap center around the thickness of the skin-subcutaneous fat-muscle complex that is used to reconstruct and also the bulkiness of the muscle pedicle, which has the potential to obscure recurrent neck disease until it is well advanced. Although it appears that this flap will rightfully become a commonly used technique, there may still be specific times when either regional skin flaps or free flaps are preferable to the pectoralis major myocutaneous flap.