The present article describes a method that preserves circulation during the preparation of the pectoralis major myocutaneous flap used in head and neck reconstruction. The major disadvantage of this flap is its poor circulation and consequent partial necrosis. To solve this problem, we analyzed the circulation and hemodynamics of the pectoralis major myocutaneous flap (the perforator of the anterior intercostal branch located about 1 to 2 cm medial to the areola in the fourth intercostal space is important), evaluated the safe donor sites in the chest wall for a skin island (the perforator is included on the skin island's central axis), improved the surgical procedure for elevating flaps (for preventing perforator injuries), and devised a means to transfer flaps, thereby increasing the range of the flaps (the transfer route is under the clavicle). Using this technique, head and neck reconstruction was performed on 62 patients. The diagnosis included oral cancer (21), oropharyngeal carcinoma (10), parotid carcinoma (10), hypopharyngeal carcinoma (9), and other head and neck malignant tumors (12). Of these, partial or marginal necrosis of the flap caused by circulatory problems was detected in three patients (5 percent). Using our method, the problems associated with inadequate circulation in the pectoralis major myocutaneous flap were greatly alleviated, thus reconfirming the usefulness of this flap in head and neck reconstruction.

In reconstruction of the nipple-aerola complex, it is important to maintain nipple projection. The conventional methods of reconstructing the nipple using local skin flaps maintain the feature for a certain period postoperatively, but the height of the nipple eventually flattens as the scars soften over time. Considering that sustaining the feature of the nipple is most important for achieving and maintaining nipple projection, we have therefore devised a new operative technique. Rolled auricular cartilage is placed in the center of the bridge of the dermal base and is wrapped with bilobed dermal-fat flaps. This technique has the following advantages: The cartilage produces and sustains a good form of the feature without subcutaneous depression because the cartilage is supported by the bridge of the dermal base. Since the dermal base forms a bridge, the method is safe, maintains good circulation, and does not lead to any necrosis in the flap. This method also was compared with a method in which the rolled auricular cartilage is wrapped with a trilobed dermal fat flap.

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