• Surgery of the lower neck and superior mediastinum is most frequently performed for parastomal recurrence of laryngeal carcinoma. It has been associated with a high incidence of complications, often leading to fatal innominate artery rupture. The use of the pectoralis major myocutaneous flap has permitted wide en bloc resections of the superior mediastinum in ten patients without a major complication. Several technical innovations add versatility to the pectoralis major myocutaneous flap, including tailor fitting each skin paddle and incorporating the pectoralis minor into the muscular pedicle. Superior mediastinal resection should be performed in conjunction with laryngectomy and cervical lymph node dissection in patients who are at high risk for parastomal recurrence. We also recommend that patients with parastomal recurrence undergo this procedure for salvage.
(Arch Otolaryngol Head Neck Surg 1987;113:73-77)
Burstein FD, Calcaterra TC. The Pectoralis Major Myocutaneous FlapUse in Surgery of the Lower Neck and Superior Mediastinum. Arch Otolaryngol Head Neck Surg. 1987;113(1):73–77. doi:10.1001/archotol.1987.01860010077019