Abstract
Recently, free tissue transfer has become very popular procedure in head and neck reconstruction. But, free tissue transfer is not available in the patient whose general condition is very poor or there is no vessels suitable for microanastomosis in the head and neck region. In this case pectoralis major M-Cf lap shoued be selected in head and neck reconstruction. Recently modified PMMC flap has been described by many workers, that is vascular pedicle island flap and preserving as much of the sternocostal part of pectoralis major muscle as possible. In this paper, we described the method that refines this modified PMMC flap by passing it through subclavicula for the purpose of more increasing pedicle length and getting more wider arc of rotation. As result this procedure has proved to increase pedicle length of approximately 3cm, and make it useful for the reconstruction of oropharynx. We have used this method in 12patients for head and neck reconstruction and get good result. Although we are afraid that postoperatively clavicula may choke vascular pedicle of the flap, there were no case that had blood circulation of flap disturbed, or rather we consider that clavicula was protector of the pedicle of flap and PMMC flap was more safely transferd to head and neck region by this procedure. Thus, in the case that free tissue transfer is unsuitable, modified PMMC flap passed through subclavicula is very useful and a safe alternative method in head and neck reconstruction.
