Approximation of muscle remnants improves cosmesis following hemimandibulectomy

2009 ◽  
Vol 123 (10) ◽  
pp. 1163-1165 ◽  
Author(s):  
P Chaturvedi
Keyword(s):  
Myocutaneous Flap ◽  
Soft Tissue Defect ◽  
Pedicled Flap ◽  
Pectoralis Major ◽  
Pectoralis Major Myocutaneous Flap ◽  
Microvascular Reconstruction ◽  
Significant Deterioration ◽  
Common Procedure ◽  
Shoulder Dysfunction ◽  
Co Morbidity

AbstractHemimandibulectomy should be avoided whenever possible, as it results in significant deterioration in quality of life. If hemimandibulectomy is unavoidable, attempts should be made to reconstruct the bone and soft tissue defect by free tissue transfer or a pedicled flap such as a pectoralis major myocutaneous flap. Bony reconstruction may become challenging when oncological safety mandates removal of the vertical ramus or the condyle. Elderly patients and those with significant co-morbidity are not suitable for prolonged microvascular surgery. Oral cancer is a disease of impoverished nations, where most health institutions may not have the infrastructure to offer microvascular reconstruction. The pectoralis major myocutaneous flap, the workhorse for reconstruction of such defects, occasionally has limitations in terms of bulk, limited arc of rotation, shoulder dysfunction etc. Therefore, hemimandibulectomy and primary mucosal closure continues to be a common procedure in developing nations. A simple technique is proposed with which to improve cosmesis following hemimandibulectomy, utilising the locally available muscle remnants. In highly selected patients, the remaining muscles can be approximated to prevent the lateral hollow that is a common but unacceptable sequel to hemimandibulectomy.

COMPLEX OROFACIAL DEFECTS -A RECONSTRUCTIVE CHALLENGE

2013 ◽  
Vol 5 (2) ◽  
pp. 56-63
Author(s):  
Rajay A. D. Kamath ◽  
Shiva Bharani K. S. N. ◽  
S Shubha Lakshmi ◽  
Amith Hadhimane
Keyword(s):  
Oral Cavity ◽  
Head And Neck ◽  
Myocutaneous Flap ◽  
Donor Site ◽  
Primary Objective ◽  
Pectoralis Major ◽  
Pectoralis Major Myocutaneous Flap ◽  
Microvascular Reconstruction ◽  
Skin Paddle ◽  
Ablative Surgery

ABSTRACT Introduction Oral cavity cancers account for 30% of head and neck cancers and represent a significant challenge to clinicians. Treatment requires multi disciplinary expertise and is complicated by. the complex role that the oral cavity plays in speech, mastication, and swallowing. Surgery remains the cornerstone of most treatment regimens; the primary objective is cure, not withstanding preservation of form and function to retain a good quality of life that can be further improved by reconstructive techniques using various local flaps, distant flaps or microvascular reconstruction. The pectoralis major [PM] flap has many advantages in that it is very reliable, and allows a single-stage reconstruction of most head and neckdefects to the level of the maxilla with well-vascularized tissue capable of carrying a large skin paddle. The donor site morbidity is surprisingly low, and few patients complain of difficulties with arm movement. Aims & Objectives This paper revisits the surgical anatomy and technique of harvesting the Pectoralis Major myocutaneous flap used to reconstruct complex defects of the lower face following composite therapeutic resection. In addition, we describe our experience using this flap and discuss associated merits and demerits and complications. Conclusion Despite contemporary micro vascular techniques, the Pectoralis Major myocutaneous flap continues to be a versatile option in the reconstruction of complex head and neck defects following ablative surgery. However, regardless of the site, stage and degree of tumor differentiation, such cases will always pose as a therapeutic challenge to the reconstructive surgeon.

scholarly journals POST-SURGICAL SHOULDER REHABILITATION OF SELECTIVE NECK DISSECTION WITH PECTORALIS MAJOR MYOCUTANEOUS FLAP RECONSTRUCTION IN “SICK” SYNDROME PATIENTS

2021 ◽  
Vol 10 (3) ◽  
pp. 2933-2936
Author(s):  
Waqar M Naqvi
Keyword(s):  
Lymph Nodes ◽  
Neck Dissection ◽  
Positive Impact ◽  
Myocutaneous Flap ◽  
Rehabilitation Program ◽  
Pectoralis Major ◽  
Pectoralis Major Myocutaneous Flap ◽  
Selective Neck Dissection ◽  
Cervical Lymph Nodes ◽  
Shoulder Dysfunction

Selective neck dissection (SND) is a surgical procedure developed to remove cervical lymph nodes at the risk of invasion metastasis. It is distinguished from radical neck dissections wherein there is the retention of one or more groups of lymph nodes. In this case, a 45-year-old male shopkeeper diagnosed with malignancy of lower anterior alveolus from 45-36 region (stage IVA –T4a N2Cm0) underwent SND, segmental mandibulectomy, and reconstruction with pectoralis major myocutaneous flap (PMMC flap) on the left side. On assessment, before the SND, Scapular mal positioning, inferior medial border prominence, coracoid pain, and dyskinesia of scapular movement (SICK) were identified. The patient was referred for physiotherapy with the complaint of inability to maintain saturation, difficulty in decannulation, and shoulder dysfunction on postoperative day 3 (POD-3). Chest physiotherapy comprising of breathing and suctioning techniques aided early decannulation. Furthermore, a prompt shoulder rehabilitation program for six months had a positive impact on the overall functioning and quality of life of the patient.

scholarly journals Utility of island bipaddle pectoralis major myocutaneous flap in reconstruction of full thickness lower gingivo-buccal sulcus defects

2020 ◽  
Vol 7 (1) ◽  
pp. 56
Author(s):  
Ravi P. Deo ◽  
Balan Ashok Kumar ◽  
Sagayaraj A. ◽  
Azeem Mohiyuddin S. M.
Keyword(s):  
Myocutaneous Flap ◽  
Stage Iv ◽  
Nodal Metastasis ◽  
Pectoralis Major ◽  
Pectoralis Major Myocutaneous Flap ◽  
Microvascular Reconstruction ◽  
Skin Involvement ◽  
Full Thickness ◽  
Medical College ◽  
Level I

<p class="abstract"><strong>Background:</strong> Aims of the study was to evaluate the usefulness of island bipaddle pectoralis major myocutaneous flap in the reconstruction of through and through lateral gingivobuccal sulcus defects.</p><p class="abstract"><strong>Methods:</strong> This was a retrospective study carried out from 2013 - 2019 in the department of otorhinolaryngology and head and surgery at Sri Devaraj Urs Medical College and Hospital. After obtaining institutional ethical committee clearance. Sixty-one patients diagnosed with stage IV a lateral Gingivobuccal squamous cell carcinoma with skin involvement and reconstructed using island bipaddle pectoralis major myocutaneous flap were included in the study.  </p><p class="abstract"><strong>Results:</strong> Majority of our patients were females. Nearly 50% of our patients had skin involvement secondary to Level-I nodal metastasis. Nine patients in our study developed complications. Among them seven patients had minor complications and in two patients the flap failed.</p><p class="abstract"><strong>Conclusions:</strong> In resource constraint places where microvascular reconstruction facilities are not available and where replacing bone is not mandatory, island bipaddle pectoralis major myocutaneous flap can be used effectively as single stage reconstruction option for full thickness lower gingivo-buccal sulcus defects.</p>

scholarly journals Reconstruction with a pectoralis major myocutaneous flap after left first rib and clavicular chest wall resection for a metastasis from laryngeal cancer

2014 ◽  
Vol 64 (5) ◽  
pp. 294-297 ◽  
Author(s):  
Francesco Paolo Caronia ◽  
Alfonso Fiorelli ◽  
Fabio Zanchini ◽  
Mario Santini ◽  
Attilio Ignazio Lo Monte ◽  
...  
Keyword(s):  
Chest Wall ◽  
Laryngeal Cancer ◽  
Myocutaneous Flap ◽  
Pectoralis Major ◽  
Pectoralis Major Myocutaneous Flap ◽  
Chest Wall Resection ◽  
First Rib

Pectoralis major myocutaneous flap for reconstruction of partial circumference hypopharyngeal defects

1996 ◽  
Vol 19 (4) ◽  
Author(s):  
S.P. Deshmukh ◽  
S.G. Patel ◽  
D.N. Savant ◽  
R. Gujarati ◽  
H.M. Bhathena ◽  
...  
Keyword(s):  
Myocutaneous Flap ◽  
Pectoralis Major ◽  
Pectoralis Major Myocutaneous Flap

Effect of Anterolateral Thigh Perforator Flap Repair on the Appearance, Language and Masticatory Function of Oral Cancer Patients after Radical Surgery

2021 ◽  
Vol 7 (5) ◽  
pp. 4277-4285
Author(s):  
Fengchun Hou ◽  
Di Wang ◽  
Tao Jiang
Keyword(s):  
Oral Cancer ◽  
Cancer Patients ◽  
Myocutaneous Flap ◽  
Perforator Flap ◽  
Pectoralis Major ◽  
Pectoralis Major Myocutaneous Flap ◽  
Control Group ◽  
Study Group ◽  
Masticatory Function ◽  
Oral Cancer Patients

Purpose: The purpose was to explore the application effect of anterolateral thigh perforator flap (ALTP) and pectoralis major myocutaneous flap on repairing the tissuedefects after oral cancer surgery. Methods: 100 oral cancer patients treated in our hospital from January 2018 to December 2020 were selected as the research objects. After both groups of patients received extended resection of tumors, neck lymph node dissection and other routine treatment, the control group was repaired by pectoralis major myocutaneous flap while the study group was repaired by ALTP to compare the flap survival rate, language, masticatory function and other related indicators between the two groups. Results: The flap harvesting time and defect repair time in the control group were shorter than those in the study group (P<0.05); The language, masticatory function and swallowing function in both groups after treatment were significantly better than those before treatment (P<0.05); The total incidence of complications in the study group was significantly lower than that in the control group (P<0.05); After treatment, the quality of life scores in both groups were significantly higher than those before treatment (P<0.05). Conclusion: Both ALTP and pectoralis major myocutaneous flap can be used to repair the tissue defects after radical resection of oral cancer, which can effective improve the postoperative appearance, language and masticatory function of oral cancer patients. However, pectoralis major myocutaneous flap has easier operation and shorter operation time while ALTP can significantly reduce the incidence of postoperative complications with higher safety.

scholarly journals Enhanced Morbidity of Pectoralis Major Myocutaneous Flap Used for Salvage after Previously Failed Oncological Treatment and Unsuccessful Reconstructive Head and Neck Surgery

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Christiana Maria Ribeiro Salles Vanni ◽  
Leandro Luongo de Matos ◽  
Mário Paulo Faro Junior ◽  
Jossi Ledo Kanda ◽  
Cláudio Roberto Cernea ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Head And Neck ◽  
Myocutaneous Flap ◽  
Neck Surgery ◽  
Cross Sectional Study ◽  
Pectoralis Major ◽  
Pectoralis Major Myocutaneous Flap ◽  
Cross Sectional ◽  
Oncological Treatment ◽  
Major Complications

Introduction. The reconstruction of complex cervicofacial defects arising from surgical treatment for cancer is a real challenge for head and neck surgeons, especially in salvage reconstruction surgery and/or failed previous reconstruction. The pectoralis major myocutaneous flap (PMMF) has been widely used in these specific situations due to its reliability and low rate of failure or complications.Objectives. Identify factors that determine complications and influence the final outcome of the reconstructions with PMMF in salvage cancer surgery or in salvage reconstruction.Methods. A cross-sectional study design was used to evaluate a sample including 17 surgical patients treated over a period of ten years that met the inclusion criteria.Results. Reconstruction was successful in 13 cases (76.5%), with two cases of partial flap loss and no case of total loss. Complications occurred in 13 cases (76.5%) and were specifically related to the flap in nine instances (52.9%). An association was identified between the development of major complications and reconstruction of the hypopharynx () as well as in patients submitted to surgery in association with radiation therapy as a previous cancer treatment (). The former condition is also associated with major reconstruction failure (). An even lower incidence of major complications was noted in patients under the age of 53 ().Conclusion. Older patients, with hypopharyngeal defects and submitted to previous surgery plus radiation therapy, presented a higher risk of complications and reconstruction failure with PMMF.

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