Abstract: PURPOSE: To explore the value of modified pectoralis major myocutaneous flap in recurrent head and neck cancer salvage surgery. METHODS: Nineteen patients with locally recurrent head and neck cancer were selected and the clinical staging was rCS stage Ⅲ in 2 cases, rCS stage Ⅳ in 17 cases. Before salvage surgery, 17 patients underwent radical tumor resection and neck dissection, 16 cases received radiotherapy. Pectoralis major myocutaneous flap was applied to reconstruct the defects after salvage surgery. During preparation, the pectoral branches of thoracoacromial vessels and branches of lateral thoracic vessels were preserved as vascular pedicle to form bipedicled fascia vascular bundle without muscle at the origin. RESULTS: All pectoralis major muscle flaps survived. Two cases developed dehiscence: after dressing for 5 weeks, 1 case had delayed healing, 1 case had pharyngeal fistula. The vascular pedicle passed through subclavian space in 13 cases, passed over the clavicle in 6 cases. The muscle pedicle length was 15.7 cm at average; the maximum length was up to 20 cm, reaching high to the marla arch. The patients were followed up for 6 to 48 months, 10 cases survived without recurrence, 5 patients survived with tumor, 4 patients died of tumor recurrence and metastasis. CONCLUSIONS: The modified pectoralis major myocutaneous flap has double artery blood supply. It avoids the occurrence of local flap necrosis and its repair radius is significantly prolonged, eliminating the accessible limit of preserving lateral thoracic vessels. It has satisfactory RESULTS in recurrent head and neck cancer salvage surgery.

Key words: Head and neck neoplasms, Recurrence carcinoma, Pectoralis major myocutaneous flap, Salvage surgery