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Study design <p>Cadaveric comparative study.</p> Objective <p>To assess the additional superior reach achievable using the pedicled pectoralis major (PM) flap with subclavicular tunnelling and clavicle osteotomy compared with the standard supraclavicular route.</p> Methods <p>Ten hemi-thoraces from fresh-frozen cadavers without prior clavipectoral surgery were dissected. Each PM flap was passed sequentially through three routes: supraclavicular, subclavicular, and mid-shaft clavicle osteotomy. Maximum superior reach from the clavicle midpoint to the ipsilateral preauricular-temporal region was measured under a standardised manual traction technique. Two observers recorded distances, and their mean value was used for analysis. Comparisons between the three routes were performed using the Friedman test and Wilcoxon signed-rank tests with Bonferroni adjustment.</p> Results <p>In this cadaveric series, mean ± SD reach was 166.6 ± 42.3&#xa0;mm (supraclavicular), 195.6 ± 37.6&#xa0;mm (subclavicular), and 215.4 ± 28.5&#xa0;mm (clavicular osteotomy). The corresponding mean gains were + 29&#xa0;mm (p = 0.006) from supraclavicular to subclavicular, + 20&#xa0;mm (p = 0.004) from subclavicular to osteotomy, and + 49&#xa0;mm (p = 0.002) from supraclavicular to osteotomy. Each step gave a measurable improvement in reach, all of which proved statistically significant.</p> Conclusions <p>Subclavicular tunnelling and clavicle osteotomy significantly increased PM flap reach by 20–50&#xa0;mm. While these gains are modest, they may be clinically useful in salvage situations where free tissue transfer is not feasible.</p>

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Extending the superior reach of the pectoralis major flap in head and neck reconstruction: A cadaveric comparative study

  • 期刊论文

  • 发表日期：

    2026年4月29日

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  • Shofiq Islam,
  • Muzzammil Nusrath

摘要

Study design

Cadaveric comparative study.

Objective

To assess the additional superior reach achievable using the pedicled pectoralis major (PM) flap with subclavicular tunnelling and clavicle osteotomy compared with the standard supraclavicular route.

Methods

Ten hemi-thoraces from fresh-frozen cadavers without prior clavipectoral surgery were dissected. Each PM flap was passed sequentially through three routes: supraclavicular, subclavicular, and mid-shaft clavicle osteotomy. Maximum superior reach from the clavicle midpoint to the ipsilateral preauricular-temporal region was measured under a standardised manual traction technique. Two observers recorded distances, and their mean value was used for analysis. Comparisons between the three routes were performed using the Friedman test and Wilcoxon signed-rank tests with Bonferroni adjustment.

Results

In this cadaveric series, mean ± SD reach was 166.6 ± 42.3 mm (supraclavicular), 195.6 ± 37.6 mm (subclavicular), and 215.4 ± 28.5 mm (clavicular osteotomy). The corresponding mean gains were + 29 mm (p = 0.006) from supraclavicular to subclavicular, + 20 mm (p = 0.004) from subclavicular to osteotomy, and + 49 mm (p = 0.002) from supraclavicular to osteotomy. Each step gave a measurable improvement in reach, all of which proved statistically significant.

Conclusions

Subclavicular tunnelling and clavicle osteotomy significantly increased PM flap reach by 20–50 mm. While these gains are modest, they may be clinically useful in salvage situations where free tissue transfer is not feasible.