Surgeon(s): ***

‍Assistant Surgeon(s):  ***

‍Preoperative Diagnosis: ***

‍Postoperative Diagnosis: Same

‍Procedure(s): ***

‍Anesthesia: General

‍Implants: None

‍Specimen:***

‍Drains: None

‍Fluids: See anesthesia record

‍EBL: Minimal

‍Complications: None

‍Counts:  Correct x2

‍Indications: ​***

‍Findings: As expected

‍Procedure in Detail:

‍The patient was seen in the preoperative holding area with a H&P was updated, consents were verified, surgical site marked, and all questions and concerns related to the proposed procedure were discussed in detail.  The patient was transferred to the operating room by the anesthesia team.  The patient underwent general anesthesia with endotracheal intubation. Tegaderms were placed over the eyes. The patient was prepped and draped in the standard fashion for maxillofacial procedures.  A time-out was performed and the procedure began.

The skin over the chest was incised following the preoperative markings designed to include a segment of the pectoralis major muscle along with the overlying skin and subcutaneous tissue. Dissection commenced along the margins of the pectoralis major, ensuring to preserve the pectoral branch of the thoracoacromial artery, which is the primary vascular supply to the flap. Careful attention was given to maintain the integrity of the vascular pedicle throughout the dissection. The muscle was then separated from the surrounding structures, and any minor bleeding points were controlled.

Once the flap was fully mobilized, the focus shifted to the recipient site in the neck. The area was thoroughly prepared, removing any nonviable tissue to ensure a healthy bed for the flap. The flap, with its skin, muscle, and vascular components, was then carefully transposed to the neck.

Finally, the flap was inset into the defect and secured with sutures. The donor site on the chest was closed primarily in layers over a drain to manage any fluid accumulation and minimize tension on the closure. The skin was closed with sutures or staples, and a sterile dressing was applied. The patient was then carefully monitored for flap viability and circulation.

The patient's face was then cleaned and the posterior pharynx was suctioned. An OG tube was used to suction out the contents of the stomach. Tegaderms were removed from the eyes. Dressings were placed. The patient was then transferred back to the care of the anesthesia team for extubation and recovery.

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