Background: The pedicle pectoralis major muscle flap is the primary workhorse flap used in head, neck, and large axillary reconstruction; however, traditional harvesting techniques may leave significant donor site scarring.

Case Report: Endoscopy-assisted harvesting of a pedicled pectoralis major muscle flap, or muscle flap and musculocutaneous flap, was performed in two patients, after which axillary defects were closed with a 4 cm incision at the 5th intercostal space using the harvested flap matching the size of the defect. The harvesting process took 40 and 32 minutes, respectively, and patients were able to return home at 5 to 7 days post-surgery. No postoperative complications were observed in either patient.

Conclusion: Endoscopic harvesting of the pedicled pectoralis major flap helps to reduce the extent of skin incisions because it gathers the pedicle vessel under the skin. Furthermore, it minimizes postoperative complications such as long hypertrophic scars.

Received 7 December 2023 | Revised 18 April 2024 | Accepted 22 April 2024

DOI: 10.35755/jmedassocthai.2024.6.13996