Head and Neck ImagingPedicled flap
tissue transferred to close a defect, while maintaining its original
vascular pedicle. Pedicled flaps may be harvested locally (in the immediate area of the defect), regionally (from the same area, but not contiguous to the defect), or at distance from the defect. The most commonly used distant flaps are musculocutaneous flaps, such as the pectoralis major flap. The pectoralis major flap has an excellent blood supply and gives acceptable functional and cosmetic results. It is commonly used to reconstruct the pharyngeal defect after laryngectomy with partial pharyngectomy; it is also very useful for closing defects in the irradiated neck, as it introduces a fresh blood supply.
On imaging studies, the pectoralis major flap appears initially as a bulky soft tissue structure, showing the characteristics of muscle; gradually, denervation muscle atrophy head and neck appears, causing volume loss and fatty replacement of the muscle (Fig.1). See laryngectomy (VI:2), Fig. 2.
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Axial contrast-enhanced CT-image. Pedicled pectoralis major flap (arrows), used to close soft tissue defect after modified radical neck dissection. Fatty infiltration of the flap due to denervation muscle atrophy. Hypertrophy of the levator scapulae muscle (asterisk), secondary to this surgical procedure.
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Pedicled flap, Fig.1 | |