STATE JOURNAL OF OTOLARYNGOLOGY 11

Pectoralis major myocutaneous flap is regarded as the workhorse for reconstruction in many head and neck surgeries and was first described by Ariyan in late 1970s. Mc Gregor and Reed in 1970 described the blood supply to skin flaps as axial or random. PMMC has both axial blood supply (distinct arteriovenous circulation along its long axis) in its proximal part as well as random supply (communicating vessels in dermal subdermal plexus) in the distal part beyond the pectoral branches of thoracoacromial artery when skin and underlying rectus fascia are included. Pectoralis major being a thick fan shaped muscle has origins from medial half of clavicle, sternocostal from manubrium and body of sternum with second to sixth costal cartilage and from rectus fascia. It is inserted into the crest of greater tuberosity of humerus. The fibers are directed from horizontal to oblique. The nerve supply is from lateral pectoral nerve which arises from the lateral cord of brachial plexus and is located medially and from medial pectoral nerve which is located laterally and originates from medial cord of brachial plexus. Lateral pectoral nerve is closely related to pectoral branch of the thoracoacromian artery and forms the neurovascular bundle. The arterial supply is from the pectoral branch of thoracoacromian artery, the lateral thoracic artery from axillary artery and from superior thoracic artery to a lesser extent. The pectoral branch of thoracoacromian artery is the main supply and it lies between pectoralis major and minor muscle, engulfed in the fascia running inferiorly along the oblique fibers of pectoralis major muscle upto the fifth or sixth rib being medial to the nipple