Preservation of Portacath With Ipsilateral Pectoralis Major Flap Harvest—Waste Not, Want Not

2020 ◽  
Vol 146 (9) ◽  
pp. 870
Author(s):  
Lauren E. Miller ◽  
Alisa Yamasaki ◽  
Daniel G. Deschler
Keyword(s):  
Pectoralis Major ◽  
Pectoralis Major Flap

scholarly journals Limited Bilateral Advancement of the Sternocostal Head of Pectoralis Major for Sternal Reconstruction: Preserving the Axillary Fold

2017 ◽  
Vol 102 (3-4) ◽  
pp. 189-195
Author(s):  
Warren M. Rozen ◽  
Ken G. W. Teo ◽  
Gausihi Sivarajah ◽  
Rafael Acosta
Keyword(s):  
Pectoralis Major ◽  
High Rate ◽  
Pectoralis Major Flap ◽  
Limited Sample ◽  
Wound Coverage ◽  
Caudal Portion ◽  
Sternal Reconstruction ◽  
The Right ◽  
Good Cosmesis ◽  
Rate Of Success

The introduction of well-vascularized flaps for infected sternotomy wound reconstruction has improved mortality rates dramatically. Multiple variations of the pectoralis major flap have been described in this context. However, unresolved limitations of this flap include poor cosmesis and problematic coverage of the inferior third of the sternotomy wound. We describe an approach to address these issues. The humeral attachments are preserved and bilateral muscles are advanced in a limited fashion. The left sternocostal head is advanced medially and rotated anticlockwise, using this portion to fill the upper half of the sternum while the caudal portion of the right pectoralis muscle is used as a turnover flap at the lower half of the wound. In all 25 patients, the anterior axillary fold was preserved bilaterally and the infection completely resolved. Complications included 3 cases of hematoma, 2 cases of coagulopathy, and 1 late bone sequestrum (aseptic). Although the study had a limited sample size, we had a high rate of success and few complications. With the preservation of bilateral axillary folds, good cosmesis, and adequate wound coverage, we recommend this modification of the pectoralis major flap in even complicated cases of mediastinitis.

Pectoralis Major Onlay vs Interpositional Reconstruction Fistulation After Salvage Total Laryngectomy: Systematic Review and Meta-analysis

2020 ◽  
pp. 019459982095796
Author(s):  
Claudia I. Cabrera ◽  
Alexander Joseph Jones ◽  
Noah Philleo Parker ◽  
Amy Emily Lynn Blevins ◽  
Mark S. Weidenbecher
Keyword(s):  
Systematic Review ◽  
Total Laryngectomy ◽  
Primary Closure ◽  
Conservative Therapy ◽  
Meta Analysis ◽  
Pectoralis Major ◽  
Pectoralis Major Flap ◽  
The Difference ◽  
Meta Analyses ◽  
English Articles

Objective To evaluate the difference in pharygocutaneous fistula (PCF) development between pectoralis major flap onlay and interpositional reconstructions after salvage total laryngectomy (STL). Data Sources Medline, Cochrane, Embase, Web of Science, CINAHL, and ClinicalTrials.gov. Review Methods A systematic review was performed during January 2020. English articles were included that described minor and major PCF rates after STL reconstructed with pectoralis major onlay or interposition. PCFs were classified as major when conservative therapy was unsuccessful and/or revision surgery was needed. Articles describing total laryngopharyngectomies were excluded. Meta-analyses of the resulting data were performed. Results Twenty-four articles met final criteria amassing 1304 patients. Three articles compared onlay with interposition, and 18 compared onlay with primary closure. Pectoralis interposition demonstrated elevated odds ratio (OR) of PCF formation as compared with onlay (OR, 2.34; P < .001). Onlay reconstruction reduced overall (OR, 0.32; P < .001) and major (OR, 0.21; P < .001) PCF development as compared with primary pharyngeal closure alone. Data were insufficient to compare interposition against primary closure. Conclusions This research shows evidence that pectoralis onlay after STL diminishes the odds of total and major PCF development. Pectoralis interposition reconstruction showed elevated odds of PCF formation as compared with pectoralis onlay.

Technique of Internal Mammary Dissection Using Pectoralis Major Flap to Prevent Contour Deformities

2009 ◽  
Vol 123 (6) ◽  
pp. 1674-1675 ◽  
Author(s):  
Anuja K. Antony ◽  
Mehul Kamdar ◽  
Andrew Da Lio ◽  
Babak J. Mehrara
Keyword(s):  
Pectoralis Major ◽  
Pectoralis Major Flap ◽  
Internal Mammary

The Pectoralis Major Flap

1992 ◽  
Vol 71 (4) ◽  
pp. 161-165 ◽  
Author(s):  
Eve C. Shank ◽  
Carl A. Patow
Keyword(s):  
Pectoralis Major ◽  
Pectoralis Major Flap
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