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Carotid artery protection by pectoralis major muscle flap
MODERN OPERATIVE TECHNIQUES
Carotid Artery Protection by Pectoralis Major Muscle Flap
YewTsu N. (Margaret) Lee, MD, FACS, Los Angeles, California
The most effective precautionary measure against carotid artery rupture after radical neck dissection is the presence of viable skin or muscular flap overlying the vessel. The use of the levator scapulae muscle for protecting the carotid artery was first advocated by Grady et al [I] in 1956. The use of other muscles such as the sternohyoid and the posterior scalene muscle, dermal graft and even pedicled omentum have been advocated by some [2]. Occasionally when one excises a large soft tissue sarcoma in the neck, there is no muscle available to cover the carotid vessel, or the neck muscles may be within the field of heavy radiation and unsuitable for use. In such cases I have detached a pectoralis major muscle flap from the humerus and brought it into the neck to wrap around the common carotid artery (Figure 1). The muscle flap is long enough to reach the base of the skull easily. The subcutaneous bulge over the clavicle is acceptable cosmetically. The muscle flap can be used either during initial radical neck dissection or for added protection when repairing orocutaneous fistula or ligating a ruptured carotid artery. Should the skin over the artery be lost, the muscle remains as a protective cover to the artery. Summary A muscle flap made of the upper portion of the pectoralis major is used to protect the carotid artery.
Figure 1. hWblllzatlon of the pectoralisma)or muscle flap, which includes only the lower 3 to 4 cm width of nwscle fibers orlglnating from the medial clavkle. tts insertion Is detached from the humerus and the muscle flap Is transfetreduptothenecksubadaneous&amfanchomdinplace with Interrupted 2-O Dexo# sutures.
This simple technique is applicable either during initial radical neck dissection or repair of orocutaneous fistula. References
From the Department of Surgery, University of Southern California School of Medicine, and Turnrx Sugety Service, Los Angeles County-USC Medical Center, Los Angeles, California. Requests for reprints should be addressed to Yeu-Tsu N. Lee, MD. Deperhnent of Surgery, Los Angeles County-USC Medical Center, 1200 North State Street, Los Angeles, California 90033.
464
1. GradyED. RobinsonJS, White JB, KrantzS. Technicalsuggestions far cancer of tha tongueand floor of the mouth.North CarolinaMed J 1958;17:46S-70. 2. GoldsmithHS. Eeattie EJ. Carotklartery protectionby pedicled ofrental wrapping.SurgGynecolObstet 1970;130:57-60.
The Amarkan Journal ol Swgary
Carotid Artery Protection by Pectoralis Major Muscle Flap
YewTsu N. (Margaret) Lee, MD, FACS, Los Angeles, California
The most effective precautionary measure against carotid artery rupture after radical neck dissection is the presence of viable skin or muscular flap overlying the vessel. The use of the levator scapulae muscle for protecting the carotid artery was first advocated by Grady et al [I] in 1956. The use of other muscles such as the sternohyoid and the posterior scalene muscle, dermal graft and even pedicled omentum have been advocated by some [2]. Occasionally when one excises a large soft tissue sarcoma in the neck, there is no muscle available to cover the carotid vessel, or the neck muscles may be within the field of heavy radiation and unsuitable for use. In such cases I have detached a pectoralis major muscle flap from the humerus and brought it into the neck to wrap around the common carotid artery (Figure 1). The muscle flap is long enough to reach the base of the skull easily. The subcutaneous bulge over the clavicle is acceptable cosmetically. The muscle flap can be used either during initial radical neck dissection or for added protection when repairing orocutaneous fistula or ligating a ruptured carotid artery. Should the skin over the artery be lost, the muscle remains as a protective cover to the artery. Summary A muscle flap made of the upper portion of the pectoralis major is used to protect the carotid artery.
Figure 1. hWblllzatlon of the pectoralisma)or muscle flap, which includes only the lower 3 to 4 cm width of nwscle fibers orlglnating from the medial clavkle. tts insertion Is detached from the humerus and the muscle flap Is transfetreduptothenecksubadaneous&amfanchomdinplace with Interrupted 2-O Dexo# sutures.
This simple technique is applicable either during initial radical neck dissection or repair of orocutaneous fistula. References
From the Department of Surgery, University of Southern California School of Medicine, and Turnrx Sugety Service, Los Angeles County-USC Medical Center, Los Angeles, California. Requests for reprints should be addressed to Yeu-Tsu N. Lee, MD. Deperhnent of Surgery, Los Angeles County-USC Medical Center, 1200 North State Street, Los Angeles, California 90033.
464
1. GradyED. RobinsonJS, White JB, KrantzS. Technicalsuggestions far cancer of tha tongueand floor of the mouth.North CarolinaMed J 1958;17:46S-70. 2. GoldsmithHS. Eeattie EJ. Carotklartery protectionby pedicled ofrental wrapping.SurgGynecolObstet 1970;130:57-60.
The Amarkan Journal ol Swgary