Combined Pectoralis Major Myocutaneous Flap with Medially Based Deltopectoral Flap for Closure of Large Pharyngocutaneous Fistulas

The pectoralis major myocutaneous flap has become the new and heavily used tool for head and neck reconstruction. This flap is reliable, versatile and allows moving large blocks of skin and soft tissue quickly, with little morbidity to the donor site. This paper describes the concept of combining the pectoralis flap with an ipsilateral medially based deltopectoral flap, to reconstruct a large pharyngostome. The skin incisions must be correctly drawn and the flaps elevated in sequence to prevent interruption of blood supply to the deltopectoral flap. Using the techniques described in the paper, rapid rehabilitation with little morbidity can be achieved.