Shrinkage of muscle flaps

LETTERS

TO

THE

173

EDITOR

candidates in the future ask one’s opinion about a career in oral surgery the reply will be more convincingly enthusiastic and less tongue in cheek. J. L. B. CARTER Queen Mary’s University Hospital, Roehampton Lane, London SW15 5PN

SHRINKAGE OF MUSCLE FLAPS Sir, I read with interest the recent paper by Phillips, Postlethwait and Peckitt, ‘The Pectoralis Major Muscle Flap without Skin in Intra-oral Reconstruction’. My limited experience of two cases would indicate that this is a satisfactory way of reconstructing defects in the oral cavity. However, I have found that in both my cases there was considerable shrinkage of the flap. I do wonder whether this is in fact due to there being no thick fascial covering to the muscle as there is in the temporalis muscle flap, rather than to denervation of the muscle; but obviously a much larger series would have to be carried out to test this hypothesis. The pectoralis major muscle flap was reported by Robertson and Robinson (1986) when as well as advocating the use of the muscle only flap they also mention covering the pectoralis muscle with split skin. Perhaps this procedure may help to reduce shrinkage. References

Phillips, J. G., Postlethwaite, K. & Peckitt, N. (1988). The pectoralis major muscle intraoral reconstruction. British Journal of Oral and Maxillofacial Surgery, Robertson, M. S. & Robinson, J. M. (1986). Pectoralis major muscle flap reconstruction. Archives of Otolaryngology-Head and Neck Surgery, 112,

flap without skin in 26, 479.

in head and neck 297.

G. H. IRVINE Department

of Oral and Maxillofacial Surgery, Southmead General Hospital, Westbury on Trym, Bristol