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Grafts and Flaps in Head and Neck Reconstruction
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Anatomy: Main supply from pectoral branch (to sternocostal head) and deltoid branch (to clavicular head) of the thoraco-acromial artery. Pectoral branch emerges near junction of middle and outer thirds of clavicle. Also supply from internal mammary perforators and lateral thoracic artery.
Head and neck
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Pectoralis major with fifth rib or edge of sternum (Ariyan S, Surg Oncol Clin N Am, 1997) – this is based on pectoral branch of thoracoacromial artery (50% of PM blood supply); the muscle is also supplied by lateral thoracic and superior thoracic arteries, 40% and 10%, respectively.
Chest wall masses and chest wall resection
Published in Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson, Operative Thoracic Surgery, 2017
Anna Maria Ciccone, Camilla Vanni, Federico Venuta, Erino Angelo Rendina
In the sternal region, the defects are usually full thickness and require skeletal and soft tissue reconstruction because of the proximity of the skin to the underlying bone. The pectoralis major muscle is the most frequent flap used in such defects. The pectoralis can be taken simply as a muscle flap or as a myocutaneous flap because of the multiple perforators entering the skin through the muscle. The pectoral branch of the thoracoacromial artery contributes the major blood supply. Release of the humeral tendon of the muscle provides a wider mobilization and rotation. For larger defects located over the mid sternum, bilateral pectoral muscle flaps may be used. When the pectoralis major is not available and one of the superior epigastric vessels is preserved, a transverse or vertical rectus abdominis flap is a good alternative. (See Figure 4.4a through c.)
The evolution of breast reconstructions with free flaps: a historical overview
Published in Acta Chirurgica Belgica, 2023
Filip E. F. Thiessen, Nicolas Vermeersch, Thierry Tondu, Veronique Verhoeven, Lawek Bersenji, Yves Sinove, Guy Hubens, Gunther Steenackers, Wiebren A. A. Tjalma
In 1976, Fujino published the first case report of a free tissue transfer to reconstruct a breast after radical mastectomy. A skin-fat-muscle flap from the upper portion of the greater gluteal muscle was harvested including the superior gluteal artery and vein. A successful microvascular anastomosis was performed connecting the superior gluteal vessels to the thoracoacromial artery and lateral thoracic vein. The same authors reported the use of a gluteal free flap for the reconstruction of a congenital aplastic breast [10,11]. In 1978, Serafin et al. were the first to describe a series of free flaps to reconstruct the breast after radical mastectomy. Ten groin flaps and two contralateral LD-flaps were used in combination with an implant in twelve patients [12]. Holmström was the first to use the abdominal pannus as donor site to reconstruct the breast. This flap was called the free abdominoplasty flap, which was based on the inferior epigastric vessels and a superficial vein [13]. Basically Holmstöm was the first to describe and perform a free TRAM flap.
Muscle flaps for sternoclavicular joint septic arthritis
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Barkat Ali, Timothy R. Petersen, Anil Shetty, Christopher Demas, Jess D. Schwartz
Important anatomical considerations at the time of resection and debridement of the SC joint are knowledge of the vascular pedicle and its innervation. The vascular pedicle to the central sternocostal segment of the pectoralis major muscle is the inferior, pectoral branch of the thoracoacromial artery which proximally runs deep to the muscle. Preservation of this blood supply is important for future reconstruction [11]. Innervation of the pectoralis major muscle is dual; medial and lateral pectoral nerves. This is important to avoid denervation of the sternocostal segment during elevation of the clavicular head [12]. There are studies describing different configurations of pectoralis major muscle, but in our series all patients received rotation advancement without release of the humeral head in case of ipsilateral flaps and with release in case of contralateral flaps [13–15]. Use of pectoralis major muscle flap after complete detachment of its origin and insertion has also been described [16].
Post-operative complications of salvage total laryngectomy forpost-radiotherapy recurrent laryngeal cancer using pectoralis major myocutaneous flaps
Published in Acta Oto-Laryngologica, 2019
Isaku Okamoto, Kiyoaki Tsukahara, Akira Shimizu, Hiroki Sato
The PMMC flap was harvested by a board-certified head and neck surgeon, from the side contralateral to the dominant hand. The form of the skin of the PMMC flap was designed to allow plication in a single-stage operation (Figure 1). The following briefly describes how the PMMC flap was harvested and applied (Figure 2). We first designed the skin flap and confirmed the outer edge of the pectoralis major muscle after making the incision. Next, we separated the rear surface of the pectoralis major muscle and confirmed pulsation and location of the thoracoacromial artery (nutritive blood vessel). The pectoralis major muscle was separated gently from the chest wall to prevent damage. While confirming the thoracoacromial artery and giving a margin of safety of around 2 cm, we separated the pectoralis major muscle toward the clavicle, as the pivot point. After raising, the PMMC flap was transferred to the neck via the supraclavicular route. Between 7 and 10 days after surgery, swallowing videofluorography (VF) was performed to ensure that no suture failure was present, then oral diet was initiated.