Pectoralis major muscle-musculocutaneous flap for chest-wall reconstruction.

Pectoralis major muscle and musculocutaneous flaps are the most frequently selected for the ventral chest wall, sternum, and anterior mediastinum because of their proximity, reliability, and versatility. These advantages are derived from consistent anatomic features that allow knowledgeable surgeons to use a variety of flap designs tailored to defect needs. The flaps can be transferred on either thoracoacromial or internal mammary vascular pedicles and can be segmentally split to achieve defect closure while retaining portions of the muscle in situ to preserve donor motor function and surface form. The musculocutaneous paddles can be placed in a variety of locations and extended beyond the muscle borders to meet specific defect needs. This anatomic versatility gives pectoralis major muscle and musculocutaneous flaps a most useful role in the reconstruction of defects of the sternum and anterior mediastinum, defects of the ventral and lateral chest wall, and intrathoracic defects such as empyema cavities and bronchopleural fistula. A detailed knowledge of surgical anatomy is essential for optimal application of these flaps in the full spectrum of clinical needs.