The pectoralis major is reliable for reconstruction of large defects in the head and neck area. In 2001, we introduced a muscle-sparing technique with preservation of the clavicular part of the muscle. So far, we did not report on its reliability and clinical outcome at the receptor site.Fifty-four pedicled segmental pectoralis major island flaps were used in 53 patients, from 2001 through 2006. As outcome measures, we studied the overall rate of complications, the rate of major complications, and the final outcome at the receptor sites. We differentiated for the types of complications and assessed operation indication (primary vs. salvage procedure), site of reconstruction, previous radiotherapy, and completeness of tumor excision as possible risk factors for complications. We compared our findings to those of a meta-analysis of 16 other studies.Complications at the receptor site were observed after 21 of the 54 operations (0.39). Eleven of these cases (0.52) required repeated surgery that was successful in 8 cases (0.72). Conservative treatment was successful in 8 cases (0.80). Final outcome was successful in 49 of the 54 operations (0.91). Previous radiotherapy was a significant risk factor for persisting complications. Salvage procedures were a significant risk factor for developing clinical fistulas and the risk of partial flap loss was significantly correlated with nonhypopharyngeal reconstructions. Our results were comparable with those found in the meta-analysis.Our muscle-sparing technique proved to be reliable with clinical results comparable with conventional techniques in addition to function preservation at the donor site.