scholarly journals HEAD AND NECK RECONSTRUCTION

2011 ◽  
Vol 18 (02) ◽  
pp. 310-316
Author(s):  
FIRDOUS KHAN ◽  
SYED ASIF SHAH ◽  
HIFSA HAMEED ◽  
Naji ullah Khan
Keyword(s):  
Oral Cavity ◽  
Head And Neck ◽  
Pedicled Flap ◽  
Pectoralis Major ◽  
Head And Neck Reconstruction ◽  
Complication Rates ◽  
Salvage Procedure ◽  
Pedicle Flap ◽  
Reconstructive Procedures ◽  
Neck Reconstruction

Background: The pectoralis major myocutaneous pedicle flap (PMMPF) has been considered to be the "workhorse" of pedicled flaps in head and neck reconstruction. Despite the use of free flaps, this flap is still considered the mainstay of head and neck reconstruction. The flap is usually associated with a high incidence of complications compared with the free fasciocutaneous flaps yet its size, viability, and versatility make it a valuable tool for extending the limits of resectability and reconstruction. It is type V muscle flap with the dominant vascular supply from the pectoral branch of thoracoacromial artery. Objective: To share our experience of pectoralis major myocutaneous pedicle flap in selected cases of head and neck reconstruction. The indications, type of reconstruction and complications of the flap utilization were evaluated. Patients and Methods: Between March 2005 and August 2010, a 37 head and neck reconstructive procedures using the PMMPF were carried out. The indications for the flap use were defects due to resection of stage II-IV cancer in the head and neck region. The site, stage of the disease and the postoperative complications were all documented. Results: Pectoralis major myocutaneous pedicled flap reconstructions were used to reconstruct defects in the following sites: oral cavity (25 patients); oropharynx/ hypopharynx, (7 patients); and neck or face (5 patients). Of the 37 PMMPF reconstructions, 30 flaps were carried out as primary reconstructive procedures, whereas 7 flaps were "salvage" procedures. Twentyfive patients (67.59%) had complications. A higher complication rates were associated with the utilization of the flap as a salvage procedure, number of co- morbidities, and in oral cavity reconstructions. Conclusions: The pectoralis major myocutaneous pedicled flap is still an acceptable method of head and neck reconstruction. It is fast, reliable, provides safe repair and is indicated especially where bulk is needed.

scholarly journals The effect of admission to intensive care unit on outcomes and complication rates after head and neck reconstruction

2018 ◽  
Vol 8 (3) ◽  
pp. 61-71
Author(s):  
F. Carta ◽  
A. Figus ◽  
N. Chuchueva ◽  
D. Quartu ◽  
G. B. Sambiagio ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Head And Neck ◽  
Postoperative Period ◽  
Early Postoperative Period ◽  
Head And Neck Reconstruction ◽  
Complication Rates ◽  
Study Objective ◽  
Reconstructive Procedures ◽  
Neck Reconstruction

The study objectiveis to evaluate the utilisation and effectiveness of intensive care unit (ICU) in the postoperative period as to its potential benefits to the head and neck reconstruction services.Materials and methods. This is a retrospective study on 143 consecutive patients who underwent 144 major head and neck microvascular reconstructive procedures performed by a single surgeon, that focused on perioperative management and on the relation between admission to ICU and complications/outcomes.Results.Thirty-four (23.6 %) patients were admitted to ICU during the early postoperative period. Admission to ICU was not associated with lower incidence of complications compared to direct admission to the Head and Neck ward: 29.4 % vs 27.3 % (p = 0.807709).Conclusion.Routinely early postoperative admission to ICU seems not to improve outcomes and/or reduce complications, and, as a consequence, ICU admission should be restricted to selected patients only.

Revisiting the sternocleidomastoid flap as a reconstructive option in head and neck surgery

2019 ◽  
Vol 133 (09) ◽  
pp. 742-746
Author(s):  
L F Jones ◽  
E M Farrar ◽  
D J H Roberts ◽  
J W Moor
Keyword(s):  
Head And Neck ◽  
Imaging Techniques ◽  
Pedicled Flap ◽  
Head And Neck Reconstruction ◽  
Complication Rates ◽  
Success Rates ◽  
Flap Surgery ◽  
Neck Reconstruction ◽  
Free Flap Surgery ◽  
Variable Nature

AbstractBackgroundThe sternocleidomastoid can be used as a pedicled flap in head and neck reconstruction. It has previously been associated with high complication rates, likely due in part to the variable nature of its blood supply.ObjectiveTo provide clinicians with an up-to-date review of clinical outcomes of sternocleidomastoid flap surgery in head and neck reconstruction, integrated with a review of vascular anatomical studies of the sternocleidomastoid.MethodsA literature search of the Medline and Web of Science databases was conducted. Complications were analysed for each study. The trend in success rates was analysed by date of the study.ResultsReported complication rates have improved over time. The preservation of two vascular pedicles rather than one may have contributed to improved outcomes.ConclusionThe sternocleidomastoid flap is a versatile option for patients where prolonged free flap surgery is inappropriate. Modern vascular imaging techniques could optimise pre-operative planning.

The Extended Pectoralis Major Flap in Head and Neck Reconstruction

1986 ◽  
Vol 94 (3) ◽  
pp. 274-278 ◽  
Author(s):  
Clarence T. Sasaki ◽  
Linda J. Gardiner ◽  
Roy D. Carlson ◽  
Thomas Vris
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Pectoralis Major ◽  
Head And Neck Reconstruction ◽  
Pectoralis Major Flap ◽  
Reconstructive Procedures ◽  
Musculocutaneous Flaps ◽  
Neck Reconstruction ◽  
Reconstructive Techniques

Historically, major extirpative surgery for control of head and neck cancer developed well in advance of reconstructive procedures that could provide acceptable functional and cosmetic rehabilitation. Introduction of cutaneous axial and random flaps— followed more recently by the description of musculocutaneous flaps—represented major advances in reconstructive techniques.

scholarly journals Factors increasing the risk of flap complications following pectoralis major myocutaneous flap reconstruction for head and neck cancers

2020 ◽  
Vol 6 (6) ◽  
pp. 1138
Author(s):  
Subbiah Shanmugam ◽  
Syed Afroze Hussain ◽  
Rajiv Michael
Keyword(s):  
Radiation Therapy ◽  
Head And Neck ◽  
Radiation Treatment ◽  
Demographic Data ◽  
Major Complication ◽  
Pectoralis Major ◽  
Head And Neck Reconstruction ◽  
Complication Rates ◽  
Flap Reconstruction ◽  
Operative Care

<p class="abstract"><strong>Background:</strong> Oral cavity cancer is one of the most common cancers and a leading cause of cancer death in India. Pectoralis major myocutaneous flaps (PMMC) are still widely used for reconstruction of defects in the head and neck, though microvascular free flaps are the ‘gold standard’. This study was aimed to identify the risk factors involved in increasing the post-operative PMMC flap complications.</p><p class="abstract"><strong>Methods:</strong> Patients who underwent surgical resection of primary head and neck cancer with PMMC flap reconstruction were included and their demographic data, pre-operative laboratory values, surgery details and post-operative flap morbidity were collected retrospectively from the master case sheets from January 2013 to December 2019. Factors such as age, gender, stage of disease, pre-operative anemia, hypoprotenemia and radiation therapy, presence of diabetes and size of the flaps were analysed to find their relation in causing flap complications.  </p><p class="abstract"><strong>Results:</strong> Totally 285 patients were included for analysis and 9.82% (n=28) had major flap complications. On analysis we found that pre-operative hypoproteinemia (serum albumin &lt;3.5) (p=0.001) and prior radiation therapy (p=0.02) significantly increased the risk of flap complications. Similarly, patients with larger bipaddled flaps had higher flap complication rates (p=0.0002) and previous radiation treatment further increased the major complication rates in bipaddle flaps.</p><p class="abstract"><strong>Conclusions:</strong> PMMC flaps are still a viable option for head and neck reconstruction especially in patients with multiple comorbidities and where free microvascular flaps are not done routinely. Careful patient selection, pre-operative optimisation and good post-operative care will help to reduce flap complications.</p><p> </p>

scholarly journals A Review Of Pectoralis Major Musculocutaneous Island Flap In Head And Neck Reconstruction In Ibadan

2000 ◽  
Vol 2 (1) ◽  
Author(s):  
O.M. Oluwatosin ◽  
F.O. Abikoye ◽  
V.O. Adegboye ◽  
A. I. Brimmo ◽  
J.T. Arotiba
Keyword(s):  
Head And Neck ◽  
Pectoralis Major ◽  
Island Flap ◽  
Head And Neck Reconstruction ◽  
Neck Reconstruction

Simultaneous reconstruction of large skin and mucosal defect following head and neck surgery with a single skin paddle pectoralis major myocutaneous flap

2005 ◽  
Vol 119 (4) ◽  
pp. 303-305 ◽  
Author(s):  
P Chaturvedi ◽  
P S Pai ◽  
K A Pathak ◽  
D A Chaukar ◽  
M S Deshpande ◽  
...  
Keyword(s):  
Head And Neck ◽  
Free Tissue Transfer ◽  
Pedicled Flap ◽  
Pectoralis Major ◽  
Head And Neck Reconstruction ◽  
Skin Defect ◽  
Skin Paddle ◽  
Tissue Transfer ◽  
Mucosal Lining ◽  
Large Skin

The pectoralis major myocutaneous (PMMC) flap is commonly used for head and neck reconstruction especially in impoverished nations. PMMC is a sturdy pedicled flap with relatively fewer complications, the learning curve is short and no specialized training in microvascular surgery is needed in order to use this flap. In a defect that requires a large skin and mucosal lining the authors routinely use either a bi-paddle PMMC or a combination of PMMC (for the mucosal lining) and a delto-pectoral flap (for the skin defect). It is indisputable that free tissue transfer is a better way of reconstruction for the majority of most such defects. Unfortunately, not all patients can be offered this form of reconstruction due to the cost, time, expertise and infrastructural constraints in high volume centres such as ours. Bi-paddling of PMMC is hazardous in obese males and most female patients. In such patients the skin defect is reconstructed usually by the delto-pectoral (DP) flap but this, for obvious reasons, is less welcomed by the patients. The authors suggest a technique wherein mucosal lining is created by the myofascial lining (inner surface) of the flap and the skin defect is reconstructed by the skin paddle of the single paddle PMMC. It should be considered wherever a DP flap is unacceptable, or bi-paddling or free tissue transfer is not possible.

A Comparison of Resource Costs for Head and Neck Reconstruction with Free and Pectoralis Major Flaps

1997 ◽  
Vol 99 (5) ◽  
pp. 1282-1286 ◽  
Author(s):  
Stephen S. Kroll ◽  
Gregory R. D. Evans ◽  
Daniel Goldberg ◽  
Bao-guang Wang ◽  
Gregory P. Reece ◽  
...  
Keyword(s):  
Head And Neck ◽  
Pectoralis Major ◽  
Head And Neck Reconstruction ◽  
Neck Reconstruction ◽  
Resource Costs
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