The deltopectoral flap v the pectoralis major myocutaneous flap. Which one?

During the past 2 1/2 years, we have used 21 deltopectoral (DP) and 25 pectoralis major myocutaneous (PM) flaps of which 25 were applied to oral and pharyngeal defects. The concurrent use of both flaps has enabled elucidation of some specific and relative advantages and disadvantages. The following five situations have been identified in which we believe the PM flap is clearly superior: (1) lateral mandibular composite resection defects; (2) large anterior segmental defects; (3) reconstitution of tongue and base of tongue; (4) radionecrosis; and (5) through-and-through defects of skin and oral cavity. The DP flap appears to hold an advantage in the repair of the following defects: (1) limited anterior mandibular loss; (2) posterior and lateral pharyngeal loss; (3) complex resections involving the palate; and (4) cervicofacial skin. The unique advantages of each flap must be weighed against certain disadvantages. Application to each reconstructive problem should be individualized. Proficiency with both flaps enhances the surgeon's ability to deal with major ablative procedures.