ABSTRACT
The pectoralis major became the workhorse in head and neck reconstruction. Raised as either a myocutaneous or muscle flap, the flap has developed a reputation for easy-to-use reconstruction. It is based on vessels of the thoracro-mial artery. The muscle exists as two portions: a clavicular head, from its sternal half, and a sternocostal head, from the sternum to the level of the seventh costal cartilage and from the upper sixth rib. It is attached by a flat tendon into the lateral lip of the inter-tubercular sulcus of the humerus. Its blood supply is based on vessels of the thoracro-mial artery. This artery, on entering the deep 'clavipec- toral fascia' of the muscle, splits into a deltoid branch to supply the humeral head and a pectoral branch to supply the remainder of the muscle. Both of these vessels are almost always sacrificed for mobilization of the flap, as the pectoral branch is almost always the dominant vessel.
