Use of the deltoid branch-based clavicular head of pectoralis major muscle flap in isolated sternoclavicular infections Faisal Al-Mufarrej, Jorys Martinez-Jorge, Brian T. Carlsen, Michel Saint-Cyr, Steven L. Moran, Samir Mardini* Mayo Clinic, 200 1st St. SW, Rochester, MN 55905, USA Received 3 June 2013; accepted 30 June 2013 KEYWORDS Sternoclavicular joint; Infection; Pectoralis muscle flap; Clavicular head Summary Background: The pectoralis major (PM) flap is the workhorse flap for acute, sub-acute and chronic sternoclavicular infections (SCIs). Attempts at using only the clavicular head of the pectoralis major muscle (CPM), based on internal mammary perforators or the thoracoacromial ar- tery, have been reported. We describe the harvest of a deltoid branch-based flap (CPM-DTA) and examine its use in managing a series of isolated, acute and sub-acute sternoclavicular infections. Methods: From 2007 to 2012, 28 subjects with SCI underwent PM flaps at our institution. Six were excluded for extensive chest wall involvement, and four were excluded from chronic osteomyelitis (5 months of infection or greater). Of the remaining 18 patients with isolated SCI, 12 underwent traditional PM flaps (Group-A), while six underwent CPM-DTA (Group-B). Features studied include age, gender, co-morbidities, culture, need for intra-operative extension of the sternoclavicular incision, postoperative complications, wound healing, time from infection onset to debridement, length of hospital stay, postoperative chest wall contour deformity and follow-up. Results: Infections resolved and wounds healed in all patients following a single reconstructive procedure. Intra-operative need for extended incisions and postoperative ipsilateral anterior chest wall contour deformity are noted in all Group-A subjects but in no Group-B subjects. Conclusion: In patients with isolated, acute and sub-acute SCI, the CPM-DTA flap achieves effec- tive wound closure while avoiding large sternal incisions and the morbidity associated with stan- dard PM muscle harvest. Harvesting the CPM-DTA flap preserves the sternocostal head of the pectoralis major muscle and its thoracoacromial pedicle. This preserves the muscle for future flap use if necessary. ª 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. * Corresponding author. Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Tel.: þ1 15072843520. E-mail address: mardini.samir@mayo.edu (S. Mardini). + MODEL Please cite this article in press as: Al-Mufarrej F, et al., Use of the deltoid branch-based clavicular head of pectoralis major muscle flap in isolated sternoclavicular infections, Journal of Plastic, Reconstructive & Aesthetic Surgery (2013), http://dx.doi.org/10.1016/ j.bjps.2013.06.057 1748-6815/$ - see front matter ª 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.bjps.2013.06.057 Journal of Plastic, Reconstructive & Aesthetic Surgery (2013) xx,1e10