The pectoralis major myocutaneous flap: Is the subclavicular route safe?

Background The pectoralis major myocutaneous flap has a proven track record as a reconstructive tool, but excessive bulk and a limited arc of rotation can be problematic. Although this can be addressed by passing the pedicle deep to the clavicle, some authors consider that this modification may compromise the flap. This prospective study therefore sought to compare the supraclavicular and subclavicular routes with particular emphasis on potential vascular sequelae. Methods One‐hundred patients were randomly allocation into two groups. Following flap harvest, the pedicle was passed in either a supraclavicular or subclavicular plane depending upon allocation. The survival rate and complications of each flap were assessed at 1 month. Results Total flap necrosis occurred in three (7.0%) of the subclavicular flaps and two (3.5%) of the supraclavicular flaps. This difference was not significant ( p = .77). Likewise no statistical difference was noted between the rates of partial flap necrosis, fistula formation infection, or secondary hemorrhage in either group. Conclusions The subclavicular route addresses the problem of pectoralis major myocutaneous flap bulk and may increase the arc of rotation of the flap without significantly compromising its vascular supply. © 2001 John Wiley & Sons, Inc. Head Neck 23: 879–884, 2001.