Abstract
In the reconstruction of large defects in the head and neck, a free rectus abdominis musculocutaneous flap having an abundant amount of tissue is a good indication. If the free flap is not available, reconstruction with a pedicled pectoralis major musculocutaneous flap is most useful. However, when a flap is harvested within a broad area, closure of the donor portion becomes difficult, and exposure of the costal cartilage is particularly problematic.
We recently experienced a case in which reconstruction with an initially free rectus abdominis musculocutaneous flap was planned, but it was judged that vascular anastomosis was difficult to carry out due to the failure of the recipient vessel.
In the present case, we performed reconstruction of the defect by using a pedicled pectoralis major musculocutaneous flap on an emergency basis. However, it was difficult to close the donor portion due to the wide range of the harvested flap. We used the rectus abdominis musculocutaneous flap, which was already raised part of the way, as the superior pedicle for covering the costal cartilage exposed in the donor site.
As in this case, it is considered that the use of a rectus abdominis musculocutaneous flap for closure of the donor site of a large pectoralis major musculocutaneous flap is one of the most effective means.
