Pectoral-branch entry-point anatomy and a standardised skeletonisation workflow for the pectoralis major island flap: an anatomical description and observational clinical analysis in adult chinese males
In brief
Skeletonised pectoralis flaps were linked to fewer severe complications: 6.8% vs 22.5%
In 194 adult Chinese men, severe 30-day complications occurred in 5 of 74 patients receiving the skeletonised flap workflow (6.8%), versus 27 of 120 receiving conventional surgery (22.5%); flap necrosis was also less frequent. The association cannot establish benefit because surgical technique was inseparable from team, and unmeasured confounding remains; multicentre validation is needed.
- Journal
- European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (Q1)
- Published
- 13 October 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Tao Li, Yidong Wu, Jialong Wu, Chao Zhang, Jing Zhou, Lifeng Li, et al.
- PMID
- 42867664
- DOI
- 10.1007/s00405-026-10593-2
Why clinicians should know about it
- Picked for Anatomy (paper of the day, 16 October 2026): Anatomic description of pectoral‑branch entry point
Abstract
PURPOSE: To define the most distal entry point (MDEP) of the pectoral branch in adult Chinese males, integrate it into a standardised Landmark-Axis-Plane (LAP) skeletonisation workflow for the pectoralis major island flap, and describe its clinical performance under IDEAL Stage 2a. METHODS: The anatomical phase measured the MDEP in 20 formalin-fixed adult Chinese male cadavers (40 hemithoraces). The clinical phase analysed 194 males (skeletonised, n = 74; conventional, n = 120) treated contemporaneously by two surgical teams at a single centre using a target trial emulation framework with propensity-score overlap weighting and logistic regression with robust sandwich variance estimation. The primary endpoint was 30-day Clavien-Dindo grade ≥ III complications. The technique and team were strictly collinear; all estimates are noncausal. RESULTS: The MDEP lay 6.2-6.5 cm below the midclavicular point, predominantly at the third rib or third intercostal space. Severe complications occurred in 5 of 74 (6.8%) skeletonised patients versus 27 of 120 (22.5%) conventional patients (weighted OR 0.27, 95% CI 0.10-0.78, P = 0.016); flap necrosis was also lower (OR 0.12, 95% CI 0.03-0.58). E-value analysis indicated that the primary association is vulnerable to moderate unmeasured confounding. QuickDASH data are descriptive only (62.8% of non-responders had died). CONCLUSION: The MDEP provides a reproducible bony-landmark reference for pedicle skeletonisation in adult Chinese males. The LAP workflow was associated with fewer severe complications, but strict technique-team collinearity and sensitivity to unmeasured confounding preclude a causal interpretation. Multicentre IDEAL Stage 2b validation is required.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.