Repeated use of the same myocutaneous flap in difficult second operations of the head and neck.

We have found that the pectoralis major myocutaneous flap is so reliable a flap that in seven selected patients we completely re-elevated, isolated, and transposed it to a new reconstructive site in the head and neck. This may be accomplished safely, despite full courses of external-beam radiation therapy to the flap. We discuss the principles of this and propose that it can be extended and applied to other island, pedicle, or free flaps. The manner in which the flap can be reused and integrated with microvascular transfer or other regional pedicle flaps in complex secondary operations must be determined by the individual reconstructive surgeon on the basis of the requirements of the reconstruction. This technique will make one more tool available to the surgeon for reconstruction.