Background: The purposes of this study were
to describe the anatomical features of a rotational flap consisting
of the clavicular portion of the pectoralis major and to report
the surgical technique and the outcome of use of this flap in a
patient with poor soft-tissue coverage following multiple operations
for a clavicular fracture complicated by nonunion and infection.
Methods: Ten shoulders from five cadavera were
dissected to isolate the clavicular portion of the pectoralis major.
The vascular pedicle, thoracoacromial artery, and axillary artery
were identified, and the length of the vascular pedicle from the
axillary artery to the muscle was measured. The angle of rotation
of the flap about its intact clavicular origin was measured before
and after division of the acromial branch of the thoracoacromial
artery. The clavicular origin was then incised, and the overall
length, width, and thickness of the muscle as well as the distance
from each end of the muscle to the vascular pedicle were measured.
Results: The average length of the vascular
pedicle from the axillary artery to the pectoralis muscle belly was
5.3 centimeters (range, 3.7 to 6.5 centimeters). The average maximum
angle of rotation with the clavicular origin intact was 60 degrees
(range, 55 to 67 degrees) before division of the acromial branch
and 73 degrees (range, 65 to 82 degrees) after division. The average
total length of the clavicular head was 20.2 centimeters (range,
18.0 to 23.0 centimeters). The average width of the clavicular head
was 2.9 centimeters (range, 2.0 to 4.0 centimeters), and the average
thickness was 0.5 centimeter (range, 0.2 to 0.7 centimeter). The
vascular pedicle entered the muscle an average of 8.7 centimeters
(range, 5.2 to 10.7 centimeters) lateral to the most medial extent
of the muscle and an average of 11.5 centimeters (range, 9.5 to
14.0 centimeters) medial to the most lateral extent of the muscle.
The rotational flap was successfully used clinically to provide
soft-tissue coverage after bone-grafting and internal fixation of
a clavicular nonunion that had been complicated by infection.
Conclusions: The clavicular head of the pectoralis
major may be used as a local rotational flap to cover soft-tissue
deficiencies over the clavicle. It can be harvested with relative
ease without damaging the sternocostal head.