Friday, May 27, 2016

Lecon: A look at innovations on the workhorse of head and neck recon



The pectoralis major myocutaneous flap is a favorite among head and neck recon surgeons because of it's relatively easy learning curve and  good arc of rotation for head and neck defects. Most surgeons should master this useful technique.

Here is an educational you tube video from Miami demonstrating their excellent technique.



An Australian group further modified the  flap by  offering some innovations on closure of the donor defect which might be difficult to close in some patients. (fig) 
Here, a fascio cutaneous flap on the aponeurosis of the rectus abdominis is included; the pect major is divided around the pedicle which is raised a s a small cuff of surrounding fascia to gain the required length of the pedicle.
The relatively large defect is closed using a medially based transposition flap ,raised as a fasciocutaneous flap. Most fasciocutaneous flaps have an excellent supply of random vessels and survive well,making them very popular flaps for reconstructive surgeons.
The flap is transposed to the defect and  the donor site closed by direct closure using this flap.


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