A Pectoralis Major Pedicled flap maintains its own blood supply and is one of the
most common ways of replacing tissue in the head and neck, particularly after neck,
throat and mouth cancers have been removed. It can be used to replace large parts
of these areas and has the advantage of an excellent blood supply and gives a good
functional and cosmetic result.
What does the surgery involve?
• Your Surgeon will tunnel a piece of skin and muscle from the pectoralis major,
along with its attached blood vessels, and transfer it to the required head and
• The chest where your pectoralis major is taken from is known as a donor site
and it will be primarily closed with sutures (stitches) and sealed with clips.
• In order to remove any excess fluid or blood from the donor site, a vacuumed
drain is likely to be put in place and monitored regularly. This will be removed
once the area stops producing excess fluid.
What will my chest be like afterwards?
• Your chest will be dressed with a dressing pad for protection and comfort and
this will be regularly checked by nursing staff.
• The dressing will be removed after approximately two to three days once the
wound has sufficiently closed, and will be covered by a waterproof dressing.
• The clips in the wound will be left in place for approximately 10 days, during
which time you can wash the area normally.
• After 10 days the clips will be removed by one of the nursing staff.
• In the period immediately after your operation, it is likely that you will find the
movement of your arm on the donor site quite uncomfortable. You will receive
regular painkillers to ease this discomfort. It is generally recommended that
only gentle movement be undertaken for the first few days, after which point
your physiotherapist will advise you of an appropriate exercise plan.
• The operation will leave you with a scar on your chest and may alter the
position of your breast/nipple. However, the scar does fade over time,
gradually becoming less visible. If scarring is of concern to you a Camouflage
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Therapist can help once the wounds have fully healed. Please ask your CNS
• You may also have a swelling on the side of your neck where the flap was
tunnelled to the head and neck. Many people find it helps to disguise this with
scarves or high-neck clothing.
What are the potential problems?
• All operations carry risks, such as bleeding and infection. All of these risks will
be explained to you in detail before you sign the consent form.
• There is a wound drain inserted into the donor site at the time of surgery and
aims to remove excess blood and serous fluid from the area, when it is
removed you may get a further collection of fluid, called a seroma. This may
require further drainage. If this is the case the Doctor can insert a small,
painless needle to drain the fluid directly from the donor site.
• In two to three per cent of cases one of the blood vessels supplying or
draining the flap can develop a blood clot. This means that the flap doesn’t get
any fresh blood or, if the drainage vein clots, the flap becomes very congested
with old blood.
• If this occurs, it usually happens within the first two days and means that you
will have to return to the Operating Theatre to have the clot removed.
Removing the clot is not always successful and, on these occasions, the flap
‘fails and an alternative method of reconstruction sought.
This leaflet has been adapted from Aintree Hospitals Patient Advice Sheets with
the authors’ permission