Background and purpose: The pedicled pectoralis major myocutaneous flap has been a common choice of tissue flaps for head and neck reconstruction. Nowadays

with rapid advancement in microsurgery

free flaps gradually replace the pedicled flaps. However

not all patients are good candidates for reconstruction surgery using free tissue flaps. Adjacent pedicled flaps are safer and more reliable. This paper explores potential application of pedicled pectoralis major myocutaneous flap in reconstruction of complex surgical defects following resection of advanced head and neck malignancies through modification of their preparation and repair method. Methods: Flap design scheme and method of preparation were modified to improve the pectoralis major muscle flap. Fifty-one patients with surgical defects from resection of head and neck malignancies received reconstruction surgery using modified pectoralis major muscle flaps. Results: Modified pectoralis major muscle flaps survived completely in 51 patients. The area of defect regained its shape and appearance after reconstruction surgery. The area of defect obtained excellent functional recovery. Postoperative functional injuries to the donor sites were minimized. Conclusion: Modification in designing and preparing method of the pectoralis major muscle flap improved repair range and distance in reconstruction of complex surgical defect following resection of head and neck malignancies. It also reduced necrosis rate of skin flaps. Postoperative donor and recipient sites regained their appearance and functions successfully. The pectoralis major muscle flap is one of the important tissue flaps used in reconstruction of surgical defect following resection of a head and neck malignancy.