HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Iblher, N. Articles by Stark, G. B. Search for Related Content PubMed Articles by Iblher, N. Articles by Stark, G. B. Related Collections Chest wall

J Thorac Cardiovasc Surg 2008;136:790-791
© 2008 The American Association for Thoracic Surgery

Brief Communication

The extended pectoralis major flap for reconstruction of the upper posterior chest wall and axilla

Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany

Received for publication October 9, 2007; accepted for publication November 25, 2007.

^_* Address for reprints: Niklas Iblher, MD, Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Hugstetter Strasse 55, 79106 Freiburg, Germany. (Email: niklas.iblher@uniklinik-freiburg.de).

The first 300 words of the full text of this article appear below.

Although the pectoralis major muscle as a basis for a variety of flaps is still a workhorse for head and neck reconstruction¹ and a flap of choice for anterior chest wall reconstruction,² coverage of dorsal upper chest wall defects including the axilla are hardly described. In certain cases when infiltration of a tumor or trauma or previous damage to the vascular supply precludes the use of adjacent muscle flaps, a pectoralis major musculocutaneous island flap can offer a valuable alternative.

Anatomy

The pectoralis major muscle originates from the medial part of the clavicle, the sternocostal border of the first 6 ribs, and the external oblique muscle aponeurosis.

The main functions of the muscle are adduction and medial rotation of the arm. Sacrifice of this muscle leads to only minimal functional deficit because adjunct muscles of the shoulder belt can almost completely compensate for the loss.³

The main vascular supply to the pectoralis muscle and its overlying skin derives from the pectoral branch of the thoracoacromial artery originating from beneath the midportion of the clavicle and coursing toward the xiphoid. Further vascular supply originates from perforating branches of the internal thoracic artery, from perforating vessels that derive from the 5th to 7th intercostal arteries, and from the lateral thoracic artery.

The skin island should be centered over the pectoralis major muscle but can be considerably extended caudally (up to a size of 45 x 18 cm and more) by including the rectus fascia owing to a rich vascular network anastomosing with the superior epigastric system,⁴ as has been shown in injection studies of the thoracodorsal system.⁵

Technique

The estimated defect is marked and an equivalent skin island is designed along the pectoralis major muscle axis ( Figure 1). The island can extend well beyond the lower border of the pectoralis muscle so . . . [Full Text of this Article]