New method of preparing a pectoralis major myocutaneous flap with a skin paddle that includes the third intercostal perforating branch of the internal thoracic artery.

Background: Although the use of free flaps has become a major option for head and neck reconstruction, the pectoralis major myocutaneous flap still plays an important role because of its advantages and its convenience as a pedicle flap located adjacent to head and neck lesions. However, there remain two problems with the pectoralis major myocutaneous flap, namely, the difficulty in preparing a small, thin skin paddle with stable blood circulation for small defects and, particularly for female cases, sacrifice of the breast. The authors report a new method of preparing a pectoralis major myocutaneous flap to solve these problems. Methods: A skin paddle is designed just above the third intercostal perforating branch of the internal thoracic artery. The pectoralis major myocutaneous flap, including the muscular branch of the third intercostal perforating branch in its muscle, is elevated. The pectoralis major myocutaneous flap is moved to the reconstruction site through the subclavian route. Results: This method was used for 11 cases with small defects in the head and neck caused by lesions. Slight marginal necrosis was observed in one case, but the other skin paddles took completely. There was no infection or fistula formation, and almost satisfactory functional results were obtained in all cases. Deformity in donor sites that included a breast was also minimal. Conclusions: With this method, it was possible to prepare the pectoralis major myocutaneous flap using a small, thin skin paddle with stable blood circulation. Breast deformation, particularly in female cases, was also kept to a minimum.