{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T15:37:25Z","timestamp":1779896245865,"version":"3.53.1"},"reference-count":29,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2023,9,6]],"date-time":"2023-09-06T00:00:00Z","timestamp":1693958400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Head &amp; Neck"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>To assess outcomes of pectoralis major myocutaneous flap (PMF) wherein the skin paddle (SP) was positioned with its distal portion extending beyond the lower border of pectoralis major by \u22652\u2009cm (PMF\u2010d).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Consecutive head and neck reconstructions with PMF\u2010d (<jats:italic>n<\/jats:italic>\u2009=\u2009110). SP dimensions <jats:italic>l<\/jats:italic><jats:sub>2<\/jats:sub> (distal extent below the lower border of pectoralis major), <jats:italic>l<\/jats:italic><jats:sub>1<\/jats:sub> (proximal extent above lower border of pectoralis major), and <jats:italic>b<\/jats:italic> (breadth) were recorded. Endpoints were SP necrosis, recipient dehiscence, early fistula, and persistent fistula.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Median values of <jats:italic>l<\/jats:italic><jats:sub>2<\/jats:sub>, <jats:italic>l<\/jats:italic><jats:sub>1<\/jats:sub>, and <jats:italic>b<\/jats:italic> were 3.0, 6.0, and 6.0\u2009cm, respectively. When <jats:italic>l<\/jats:italic><jats:sub>2<\/jats:sub>\u2009=\u20092.0\u20133.0\u2009cm, SP necrosis occurred in only one (1%) subject (with obesity). When <jats:italic>l<\/jats:italic><jats:sub>2<\/jats:sub> was \u22653.5\u2009cm, necrosis occurred in four (16%) subjects, three of whom also had <jats:italic>l<\/jats:italic><jats:sub>1<\/jats:sub>\/<jats:italic>l<\/jats:italic><jats:sub>2<\/jats:sub>\u2009&lt;\u20092.0 (proximal SP\u2009&lt;\u200967% of entire SP). Statistically, increased <jats:italic>l<\/jats:italic><jats:sub>2<\/jats:sub> was the only risk factor for necrosis (<jats:italic>p<\/jats:italic>\u2009=\u20090.001). Overall, incidence of recipient dehiscence, early fistula, and persistent fistula were 32 (29%), 20 (20%), and 3 (3%), respectively. Persistent fistula occurred only in the setting of SP necrosis and\/or re\u2010irradiation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Careful patient selection, adequate proximal SP, and <jats:italic>l<\/jats:italic><jats:sub>2<\/jats:sub>\u2009=\u20092.0\u20133.0\u2009cm is associated with a negligible risk of necrosis. The enhanced reach and laxity and additional skin surface area and soft tissue volume conferred with PMF\u2010d facilitate recipient wound healing.<\/jats:p><\/jats:sec>","DOI":"10.1002\/hed.27508","type":"journal-article","created":{"date-parts":[[2023,9,6]],"date-time":"2023-09-06T10:41:08Z","timestamp":1693996868000},"page":"2819-2828","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Distal positioning of the skin paddle of pectoralis major myocutaneous flap in head and neck reconstruction"],"prefix":"10.1002","volume":"45","author":[{"given":"Muthuswamy","family":"Dhiwakar","sequence":"first","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery KMCH Institute of Health Sciences and Research  Coimbatore India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeevithan","family":"Shanmugam","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Community Medicine KMCH Institute of Health Sciences and Research  Coimbatore India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zubair A.","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery KMCH Institute of Health Sciences and Research  Coimbatore India"},{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery Central Hospital  Sharjah United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shivprakash","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery KMCH Institute of Health Sciences and Research  Coimbatore India"},{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery KEM Hospital  Pune India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konagalla","family":"Karthik","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery KMCH Institute of Health Sciences and Research  Coimbatore India"},{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery Krishna Institute of Medical Sciences  Ongole India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,9,6]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000008423"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2020.01390"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40463-019-0334-y"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9610(05)80541-0"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/archfaci.2009.67"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.133.5.490"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(97)00152-1"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.PRS.0000156972.66044.5C"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9610(80)90201-9"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/0007-1226(84)90151-6"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199111000-00012"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/019459988609400302"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000637-199810000-00023"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.26799"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/NT.0000000000000092"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000003947"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.33103"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-197964050-00002"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/lio2.112"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.26789"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2013.03.043"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0b013e3181f81634"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9610(84)90106-5"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/0278-2391(90)90533-8"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199607000-00006"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199903000-00009"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-010-1203-5"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijom.2013.10.009"}],"container-title":["Head &amp; 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