Pectoral myocutaneous island flap for reconstruction of stomal recurrence.

In 1962, one of us (G.A.S.) reported six mediastinal dissections for stomal recurrence after laryngectomy. Reconstruction of the superior mediastinum depended on the use of several regional flaps. Adequate soft-tissue and muscle coverage is mandatory to avoid major complications in this (usually) previously radiated and/or surgical field. Seven cases in which the greater pectoral myocutaneous island flap was successfully used for a one-stage reconstruction after ablative surgery for stomal recurrence have been reported in the literature. Our series of six patients supports the use of this flap in reconstruction after mediastinal dissection. Partial skin sloughing occurred in two patients. In one patient, a major complication of necrosis of the flap and an innominate artery rupture occurred. A review of this last case reinforces the necessity of adequate artery coverage in reconstruction.