Pectoralis major flap in composite lateral skull base defect reconstruction

Objective: To report our experience with the pectoralis major myocutaneous flap (PMF) for the reconstruction of composite lateral temporal bone defects extending beyond the temporal line. Design: Retrospective review and illustration of specific technical modifications. Setting: Academic tertiary care center. Patients: Eight patients with composite lateral skull base defects that were reconstructed with the PMF between February 2001 and February 2006. Intervention: Reconstruction with the modified pedicled PMF. Main Outcome Measures: Reconstruction outcomes and complications. Results: Eight patients (median age, 80 years) underwent total or near-total auriculectomy, wide skin excision, and lateral temporal bone resection as part of the surgical ablation, thus requiring obliteration of the middle ear cavity as well as extensive replacement of skin cover. All patients received radiation therapy. The median post-surgical follow-up was 9 months. Complete healing of the reconstructed surgical defect with no flap loss was achieved in all cases. Conclusion: With specific technical modifications, the PMF can be reliably used for the reconstruction of composite lateral skull base defects extending up to and beyond the temporal line, making this flap an important alternative to free flap reconstruction in selected cases.