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 postsurgical 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.