Split pectoralis major myocutaneous flap.

A variation of the pectoralis major myocutaneous flap in head and neck reconstruction is presented. The defect to be covered was a large, intraoral, U-shaped defect extending from the left tonsillar region around the alveolar ridge and floor of mouth to the right soft palate and buccal mucosa. Nearly the entire tongue was intact, and a 4 cm left mandibular segmental defect existed. A single left pectoralis major myocutaneous island flap was split longitudinally to resurface the defect. Implications of vertical splitting of a myocutaneous flap are discussed with respect to blood supply and limits.