Vascular Compromise of the Pectoralis Major Musculocutaneous Flap in Head and Neck Reconstruction

In Brief In head and neck reconstructive surgery, the pectoralis major musculocutaneous flap is a major reconstructive tool, both in primary as well as secondary reconstructions. In a few cases the authors have been able to demonstrate that when the pectoralis major musculocutaneous flap is translocated to the mouth through a noncompromised neck tunnel, as is done for head and neck reconstructions, the taut lateral pectoral nerve is seen to compress the vascular pedicle of the flap, adversely affecting its vascularity, which can lead to partial or total necrosis of the flap. The authors explain this feature, very specific to this flap, with the help of a prospective series of patients. During intraoperative inspection of 10 pectoralis major musculocutaneous flaps used in head and neck reconstruction, three showed the lateral pectoral nerve coursing inferior to the vascular pedicle, and all three demonstrated obstruction of the vascular pedicle by the nerve. Sectioning of the nerve corrected the problem.