Chapter 22 - Famona Site

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4. Hypopharynx.5. Neck skin (and opposite neck).6. Mandible and soft tissue.7. Esophagus.1. Sacrifice of the accessory nerve.2. Bulkiness.Drawbacks3. Donor site may require a skin graft.4. Often the base of the flap is too thick for primary intraoral covering and requiresa controlled orocutaneous fistula.Pectoralis Major (PM)AnatomyThis broad, flat, and fan-shaped muscle has its origin from the medial portion of theclavicle (horizontal fibers), the sternum, and the upper six costal cartilages. The fibers, afterreaching maximum span over the chest wall, converge into a large tendon that attaches to thelateral tip of the bicipital groove of the humerus.1. Thoracoacromial artery.Arterial Supply2. Lateral thoracic artery (nondominant).1. Medial pectoral nerve.2. Lateral pectoral nerve.Nerve SupplyPM ActionThe PM muscle bundles adduct the arm and medially rotate it. The clavicular fibersassist in the flexion of the arm.14
Operative Technique1. The paddle is outlined on the chest wall along the vascular strip. Place marks onthe shoulder tip and xyphoid and join these points. The artery is drawn exiting from underthe midportion of the clavicle perpendicular to this line.2. Skin and subcutaneous tissue is incised along the lateral border of the paddle.3. Muscle bundles are split and dissection is carried deep to the muscle to avoid injuryto the vascular pedicle (include fascia).4. Using a retractor, elevate the muscle and deep fascia for direct visualization of theneurovascular bundle.5. Suture deep dermal layers to the underlying fascia with 3-0 chromic suture to avoidavulsion of the flap.6. As the dissection is carried superiorly, keep the neurovascular pedicle in view atall times.7. The infraclavicular attachments are separated.8. The pectoral nerve is cut.9. The flap is turned over the clavicle and placed in the reconstructive site.10. The donor site is closed primarily and drained.Reconstruction of:1. Base of tongue/anterior tongue.2. Floor of mouth.3. Pyriform sinus.4. Esophageal defects.5. Mandible and soft tissue.6. Temporal bone resection site.7. Orbital defects.8. Neck skin defects.Indications for Use15
Page 1 and 2: K. J. Lee: Essential Otolaryngology
Page 3 and 4: Vascularization and graft take depe
Page 5 and 6: 6. Can be used on a host bed of que
Page 7 and 8: Transposed, Advancement, and Interp
Page 9 and 10: D. Bed:1. To have well-nourished re
Page 11 and 12: Arterial Supply1. Occipital artery.
Page 13: Nerve Supply1. Spinal accessory ner
Page 17 and 18: 3. Initial incision is begun in the
Page 19 and 20: evaluated for subsequent removal at
Page 21 and 22: orbital fat, the skin muscle flap i
Page 23 and 24: FaceliftPreoperative EvaluationA. T
Page 25 and 26: nerve.b. Below the zygomatic arch,
Page 27 and 28: 2. The diagnosis of hematoma is bas
Page 29 and 30: a. Relaxed skin tension lines are s
Page 31 and 32: c. Because of the marked irregulari

Chapter 22 - Famona Site

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