13.5.

4 PECTORALIS MAJOR FLAP Ariyan, PRS, 1979 Anatomy

Origin sternocostal heads (upper 6 ribs) , cla icular head !nsertion bicipital groo e o" hu#erus$ %er e supply lateral and #edial pectoral ner es$ &lood supply thoracoacro#ial and lateral thoracic Action adductor and #edial rotation o" hu#erus &ac'(to("ront )*+

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Surface mark n!" *e#onstrate by resisted adduction o" the ar# 5or#s the anterior border o" the a6illa Pectoral artery line "ro# acro#ion to 6iphisternu#$ o *ra. line Acro#ion to 6iphi o 7o 1-0 along cla icle "ro# acro#ion$ *rop a ertical line to 8oin pre ious line 9 pedicle

#"e$ :ead and nec' reconstruction Sternal ;ound *ehiscence

F%a& &%ann n! S'in paddle #edial to nipple :ori<ontal bac' cut preser es the deltopectoral "lap as sal age *irect closure possible .ith an ele#ent o" rotation in s#all "laps *issect out the in" border$ )i"t up the #uscle to see the pedicle ;ide #uscle cu"" enco#passing the thoraco(acro#ial essels$

=odi"ication ( Pal#er and &achelor) "unctional island "lap )arge olu#e de"ects better than R555 Reduces shoulder dys"unction "ollo.ing radical nec' dissection trape<ius dener ated Sternocostal and cla icular heads intact Pectoral branch o" thoraco(acro#ial a6is dissected o" the o erlying #uscle$ !slanded "lap deli ered through a button hole in the cla icular head !ncrease pedicle length (>0c#) greater arc o" rotation, less co#pro#ise o" sho?ulder "unction$

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