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
October 13, 2026 · via Europe PMC
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.
Li T, Wu Y, Wu J, Zhang C, Zhou J, Li L, Chen X.
AI summary — for doctors, generated from the abstract only
A bony-landmark entry point for the pectoral branch and a standardised skeletonisation workflow for the pectoralis major island flap were associated with fewer severe complications, but the comparison cannot support causal claims.
What was studied
Cadaveric anatomy study of 20 formalin-fixed adult Chinese male cadavers (40 hemithoraces) to locate the most distal entry point (MDEP) of the pectoral branch, plus a single-centre observational comparison of 194 males (74 skeletonised, 120 conventional) using target trial emulation with propensity-score overlap weighting.
Key findings
- The MDEP lay 6.2-6.5 cm below the midclavicular point, mostly at the third rib or third intercostal space.
- Grade III or higher 30-day complications occurred in 5 of 74 (6.8%) skeletonised 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 with the new workflow (OR 0.12, 95% CI 0.03-0.58).
- QuickDASH data are descriptive only, as 62.8% of non-responders had died.
Clinical relevance
Surgeons performing pectoralis major island flap reconstruction may use the MDEP as a reproducible bony reference when skeletonising the pedicle, at least in adult Chinese males.
Who should care
Limitations
Technique and surgical team were strictly collinear, so effects cannot be separated; the authors state all estimates are noncausal. E-value analysis showed vulnerability to moderate unmeasured confounding, the sample was single-centre and male only, and QuickDASH follow-up was compromised by deaths among non-responders.
The landmark is reproducible and the workflow looks promising, but multicentre IDEAL Stage 2b validation is needed before it can be considered better than conventional dissection.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
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.
DOI
10.1007/s00405-026-10593-2
PMID
42867664
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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