Supercharged pectoralis major musculocutaneous flap.

The pectoralis major musculocutaneous (PMMC) flap was once considered the workhorse for head and neck reconstruction; however, because of the proliferation of free tissue transfer, it has rightly taken on a secondary role. Nevertheless, in certain head and neck reconstructions, the PMMC flap remains the last-line treatment and the only salvage option in do-or-die scenarios. The conventional harvesting method of the PMMC flap cuts the lateral thoracic artery and all intercostals branches from the internal mammary vessel to avoid compromising pedicle length. Nonetheless, the dissection of these 2 dominant sources of blood supply to skin islands overlying the lower PMMC flap poses a potentially high risk of distal flap necrosis.To preserve the lateral thoracic vessels, the PMMC flap is a very valid choice from the viewpoint of blood supply. In a novel surgical procedure named "Supercharged Pectoral Major Musculocutaneous Flap"-"SUP-PMMC flap"-devised by us, the lateral thoracic vessels near the bifurcation of subclavian vessels are cut and then anastomosed to the cervical vessels. The procedure causes no vascular insufficiency of skin islands and no compromise to the length of the pedicle and is valid from the viewpoint of blood supply to the lower part of PMMC flaps. The author used this technique in 4 head and neck cancer reconstructions, and no partial flap necrosis or fistula formation was observed.