Pectoralis Major Myocutaneous Flap in Head and Neck Reconstruction:An institute Experience in 200 Consecutive Cases
Pectoralis Major Myocutaneous Flap in Head and Neck Reconstruction
DOI:
https://doi.org/10.70284/njirm.v10i4.2537Keywords:
: Reconstruction, Head and Neck Surgery, PMMC flapAbstract
Introduction : Reconstruction of head and neck defects is a challenging task. That is very important to restore form and function of appearance, speech, swallowing. In 200 patients we have analyzed different aspects following soft tissue reconstruction in respect to reliability of flap versus restoration of form and function. Methods: We retrospectively analyzed 200 patients that received Pectoralis Major Myocutaneous flap (PMMC) as a form of reconstruction, from 2011 to 2018, performed at GCS Medical College and Hospital, Ahmedabad. The total of 200 (n=200) PMMC flap reconstructions were performed. Results: 200 patients were reviewed for study. Most tumors were advanced (T3 or T4a) lesion. 198 reconstructions were done as a primary procedure, and 2 were salvage procedure. PMMC flap was used to cover only mucosal defect in 154 patients, skin and mucosal in 46 patients. Flap related complications were classified. None of the patients had total flap necrosis. 20 patients had infections which resolved by conservative management. Minor complications and donor site complications included fistulas (that were managed conservatively); wound dehiscence (not requiring additional surgery other than resuturing), local infections, seromas, and hematomas. Conclusion: PMMC flap is a workhourse flap with excellent reach to the oral cavity and face and neck region. With limited expertise and resources it is still a primary choice. It lacks in the bulk available after a time period. [Shah G Natl J Integr Res Med, 2019; 10(4):66-69]
References
1. Blakwell KE, Buchbinder D, Biller HF, Urken ML. Reconstruction of massive defects in head and neck: The role of simultaneous distant and regional flaps. Head Neck 1997;19:620-8.
2. Vijay R. Ramakrishnan, MD; William Yao, BS; John P. Campana, MD. Improved Skin Paddle Survival in Pectoralis Major Myocutaneous Flap Reconstruction of Head and Neck Defects. Arch Facial Plast Surg. 2009;11(5):306-310.
3. McCRORY al, Magnuson JS. Free tissue transfer versus pedicled flap in head and neck reconstruction. Laryngoscope 2002;112:2161-5.
4. Ariyan S. The pectoralis major myocutaneous flap: A versatile flap for reconstruction in the head and neck. Plast Reconstr Surg 1979;63:73-81.
5. Varnian JG, Carvalho AL, Carvalho SM, Mizobe L, Magrin J, Kowals k i LP. Pectoralis major and other mayofascial/mayocutaneous flaps in head and neck cancer reconstruction: Experience with 437 cases at a single institute. Head Neck 2004;26:1018-23.
6. Talesnick A,Markowitz B,Calcaterra T, Ahn C, Shaw W. Cost and outcome of osteocutaneous free tissue transfer versus pedicled soft tissue reconstruction for composite mandibular defects.Plast Surg 1996;97:1167-78.
7. Mclean JN, Carlson GW, Losken A. The pectoralis major mayocutaneous flap revisited: A reliable technique for head and neck reconstruction. Ann Plast Surge 2010; 64:570-3.
8. Shah GH, Mistry M, Pandit J. Pectoralis Major Myocutaneous Flap in Head and Neck Reconstruction : An Experience in 100 Consecutive Cases. GCSMC J Med Sci Vol (V) No (I) January-June 2016.
9. Croce A, Moretti A, D'Agostino L, Neri G. Continuing validity of pectoralis major flap 25 years after its first application. Acta Otorhinolayngol Ital 2003;23:297-304.
10. Liu R, Gullane P, Brown D, Irish J. Pectoralis major myocutaneous pedicled flap in head and neck reconstruction: Retrospective review of indications and results in 244 consecutive cases at the Toronto General Hospital. J Otolaryngol 2001;30:34-40.
11. Shah JP, Haribhakti V, Lorre TR, Sutaria P. Complications of pectoralis major myocutaneous flap in head and neck reconstruction.AmJ Surg 1990;160:352-5.
12. Freeman JL, Walker EP, Wilson JS, Shaw HJ, The vascular anatomy of pectoralis major mayocutaneous flap. Br J Plast Surg 1981;34:3-10.
13. Milenovic A, Virag M, Uglesic V, Aljinovic-Ratkovic N. The pectoralis major flap in head and neck reconstruction: First 500 patients. J Craniomaxillofac Surg 2006;34:340-3.
14. Rikimaroo H, Kiyokawa K, Inoue Y, Tai Y. Three dimentional anatomical vascular distribution in the pectoralis major mayocutaneous flap. Plat Surge 2005; 115:1342-52.
15. Cunha-Gomes D, Chaudhary C, Kavarana NM. Vascular compromise of the pectoralis major mayocutaneous flap in head and neck reconstruction. Ann Plast Surge 2003; 51:450-4.
16. Mayank Tripathi, Snjeev Parshad, Rajender Kumar Karwasra, Virender Singh. Pectoralis major myocutaneous flap in head and neck reconstruction: an experience in 100 consecutive cases. National journal of Maxillofacial Surgery 2015; 6:37-41.
