Modified harvesting technique for pedicled pectoralis major muscle flap after extended manubrial resection in case of recurrent cervicothoracic junction tumors.

Introduction: The problem of the replacement after manubrial resection can be solved standardly through a pedicled pectoralis major muscle flap (PMMF) defect coverage, harvested thought an accessory incision. We recently established an alternative and easier harvesting technique, also in critical cases (patients with recurrent tumor and after radio-chemotherapy), that improves aesthetic outcome and allows harvesting an adequate muscle flap for an optimal chest wall coverage.

Material and methods: A single center retrospective analysis between 2017 and 2020 was performed. Flap harvest was performed subcutaneously using the same incision resections line, thereby sparing the clavicular and upper sternocostal aspects of the pectoralis muscle.

Results: Fifteen patients with recurrent tumors after radio-chemotherapy and involving the upper thoracic inlet underwent manubrial resection with associated extended upper mediastinal dissection and replacement using a pectoralis major island flap following our harvesting technique. The majority (70%) of patients had an uneventful course of recovery and showed satisfying aesthetic results and low donor site morbidity. Four (26%) patients had major complications that required surgical revision. All patients had early postoperative shoulder mobilization without functional deficit or aesthetic deformity.

Conclusions: Pedicled pectoralis major muscle flap (modified harvesting) provides an adequate replacement of the upper thoracic inlet, with excellent aesthetic and functional results, also in high risk patients.