Clavicular division technique. A new approach for lengthening the pectoralis flap.

Complications associated with using the pectoralis major myocutaneous flap increase significantly when a portion of the paddle is randomized and/or the flap is closed under tension. The clavicular division technique was devised to increase the length of the flap to help alleviate this problem. Thirty pectoralis major muscle flaps were dissected in fresh cadavers, using the clavicular division technique. The length of the flap after transposition was measured and recorded before and after clavicular division. The distance from the sternal notch to the clavicular division point was also recorded. The average gain in length was found to be 2.9 cm, with a range of 0.5 cm to 6.5 cm. The clavicular division technique has been used since in five patients. The increase in length has allowed us to discard some or all of the random portion of the flap. We advocate the use of this procedure on any patient where the surgeon is concerned about the viability of the random portion of the flap and/or when it is felt that the tension on the suture line is excessive.