Subclavicular Route for Pectoralis Major Myocutaneous Flap: Our Novel Experience

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Subclavicular Route for Pectoralis Major Myocutaneous Flap: Our Novel Experience

Mohammad Adzwin Yahiya, Shah Kamal Khan Jamal Din, Mukhriz Hamdan, Victor Ooi Keat Jin: Subclavicular Route for Pectoralis Major Myocutaneous Flap: Our Novel Experience. Mal. J. Oral Maxillofac. Surg. 2012; 10: 28–33.

Abstract: The aim of this paper was to discuss the risks and benefits of subclavicular route through literature review and to report our novel experience. Pectoralis major myocutaneous flap (PMMF) has always been the mainstay in the immediate reconstruction of defects of the head and neck region, despite recent advances in microvascular surgical techniques and the development of several free flaps. This is particularly so in those services where free flaps are not routinely available. The tissue is abundant with an excellent axial vascularization by the thoracoacromial artery. Its anatomic proximity facilitates the immediate reconstruction of a variety of defects in the head and neck area. Several modifications regarding the original technique have been published. Among these technical modifications, the subclavicular route for PMMF transfer to the head and neck region has been widely adopted by many surgeons. This is because the supraclavicular route can be problematic due to excessive bulk of the tissue and a limited arc of rotation. Some authors consider that this modification may compromise the flap. Due to the narrow space between the clavicle and the subclavian vessels, the passage of the PMMF under the clavicle may not be an easy manoeuvre. Subclavicular approach decreases the bulk of the flap pedicle which is functionally and cosmetically favourable. Subclavicular approach may be a difficult manoeuvre that could put the neurovascular bundle and the integrity of the vascular pedicle at risk. Sound knowledge on technique and anatomy is important. Indication should be evaluated on a case-by-case basis.