The Split Pectoralis Flap: Combining the Benefits of Pectoralis Major Advancement and Turnover Techniques in One Flap

Background: The pectoralis major is a versatile flap used as an advancement or turnover flap for sternal wound treatment. The advancement flap provides suboptimal inferior sternal coverage and poorly fills mediastinal dead space. The turnover flap covers the inferior sternum and fills dead space but requires disinsertion of the muscle from the humerus, resulting in functional loss and cosmetic deformity. Methods: The authors describe a new technique of splitting the pectoralis muscle along its fibers, using the superior portion as an advancement flap and the inferior portion as a turnover flap. Results: Eleven patients underwent the described technique. Nine patients healed without complications or repeated operations. One patient had a recurrent aortic graft infection requiring reoperation. One patient had a postoperative seroma requiring incision and drainage. Conclusion: Using the pectoralis as an advancement and turnover flap allows inferior sternum and mediastinum coverage using one donor site and maintaining the function of the muscle and preventing cosmetic deformity.