HEAD AND NECK The changing role of pectoralis major flap in head and neck reconstruction Hin-Lun Liu • Jimmy Yu-Wai Chan • William Ignace Wei Received: 28 February 2010 / Accepted: 28 April 2010 / Published online: 12 May 2010 Ó Springer-Verlag 2010 Abstract Although pectoralis major flap (PM flap) has been used as the workhorse flap in head and neck recon- struction, its use in head and neck defects seems to fall out of favour in the era of free tissue transfer. The aim of this review is to find out the role of PM flap in modern head and neck surgery. Medical records of patients who underwent PM flap reconstruction for head and neck defect in our division were reviewed. The age, gender, flap type, indi- cation and complication rate were described. Between January 1998 and December 2008, 202 PM flaps were used for head and neck reconstruction in 192 patients. In the early study period (1998–June 2003), out of the 119 PM flap reconstructions, 106 (89%) were performed for immediate reconstruction after resection of head and neck tumour, while 10 (8%) were performed as salvage procedures for complication after tumour resection e.g. failure of free flap, pharyngocutaneous fistula. In the late study period (July 2003–2008), out of the 83 PM flap reconstructions, 58 (70%) were performed for immediate reconstruction, while 24 (29%) were performed as salvage procedures. For immediate reconstruction after tumour extirpation, 51 flaps (48%) were performed for recon- struction of the tongue in the early study period, while only 14 (24%) were performed in the late study period. The number of PM flap used for immediate reconstruction for other head and neck defects remained relatively static throughout the two study periods. Over the study period, there were 10 (5%) cases of partial flap necrosis and 2 (1%) total flap loss, making the overall flap necrosis rate 6%. In the era of free tissue transfer, the role of PM flap in head and neck surgery has shifted from immediate reconstruc- tion to salvage operation. However, PM flap still has an unique role in the repair of certain head and neck defects. Keywords Pectoralis major flap Á Head and neck reconstruction Á Immediate reconstruction Á Salvage Introduction Pectoralis major flap (PM flap) has been described as a good friend of plastic surgeons as it is reliable and easy to be raised. It has been the workhorse flap for head and neck reconstruction since the 1970s. However, with the maturation of the microvascular surgery technique in the recent decades, head and neck reconstruction now nearly equates free tissue transfer. In the era of free tissue transfer, the use of PM flap in head and neck recon- struction seems to fall out of favour. The aim of this review is to find out the role of PM flap in modern head and neck surgery. Patients and methods Patients who underwent PM flap reconstruction for head and neck defects in our division between January 1998 and December 2008 were included in this study. The medical records of these patients were reviewed. The indications of PM flap reconstruction included immediate reconstruction after head and neck tumour resection, salvage for compli- cations after head and neck tumour surgery (e.g. failed free flap, pharyngocutaneous fistula) and other benign non- tumour head and neck conditions (e.g. facial trauma). H.-L. Liu (&) Á J. Y.-W. Chan Á W. I. Wei Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China e-mail: lawrencehlliu@gmail.com 123 Eur Arch Otorhinolaryngol (2010) 267:1759–1763 DOI 10.1007/s00405-010-1271-6