Evaluation of pectoralis major myocutaneous flap at tertiary care hospital: retrospective study of 60 cases

Background: Reconstruction following advanced oral cancer is a formidable task in developing country, with poor infrastructure and heavy chunk of advanced stage (T3-T4) oral malignancy. Options available for reconstructions are regional pedicle flaps and microvascular free flaps. Pedicle flaps particularly the pectoralis major myocutaneous (PMMC) flap have an easy learning curve for most of surgeons. Pectoralis major myocutaneous flap is regarded as the workhorse for reconstruction in many head and neck surgeries.Methods: A study was undertaken on patients of soft tissue defects of head and neck region after resection of tumor of oral cavity (squamous cell carcinoma). Total 60 patients, who were managed in ENT department, Sir T hospital, Bhavnagar from 2016-19 were included in this study. Results: Gingivo-buccal complex was the most common site observed for oral malignancy and majority of patients were in TNM stage-I, II, III in this study. Apart from total flap necrosis observed in 1 patient, in rest all the patients PMMC flap very well survived with some major/minor, flap related and unrelated complications.Conclusions: The PMMC flap is effective in reconstruction of defect after excision of oral cavity cancers in developing country with heavy chunk of oral cavity cancer patients. In spite of several minor flap related and flap unrelated complications, PMMC flap survival rate is high and total flap necrosis rate is very low.

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COMPLEX OROFACIAL DEFECTS -A RECONSTRUCTIVE CHALLENGE

CODS Journal of Dentistry ◽

10.5005/cods-5-2-56 ◽

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.

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

The Scientific World JOURNAL ◽

10.1100/2012/384179 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 5

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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