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Mohan AM, Balaguhan B, Krishna V, Nagarjuna M. Squamous Cell Carcinoma of the Pectoralis Major Myocutaneous Flap Donor Site. J Oral Maxillofac Surg 2014; 72:1425-31. [DOI: 10.1016/j.joms.2013.12.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 12/14/2013] [Accepted: 12/19/2013] [Indexed: 10/25/2022]
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Nagarjuna M, Patil BR, Nagraj N, Gopalkrishnan K. Use of superiorly based vertical rectus abdominis myocutaneous flap for the correction of costal osteomyelitis at the pectoralis major myocutaneous flap donor site. J Oral Maxillofac Surg 2013; 71:e132-6. [PMID: 23351766 DOI: 10.1016/j.joms.2012.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 10/03/2012] [Accepted: 10/08/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Muralidhara Nagarjuna
- Department of Oral and Maxillofacial Surgery, SDM College of Dental Sciences, Karnataka, India.
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Kim DD, Ghali GE. Postablative reconstruction techniques for oral cancer. Oral Maxillofac Surg Clin North Am 2007; 18:573-604. [PMID: 18088854 DOI: 10.1016/j.coms.2006.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- D David Kim
- Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71103, USA
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Cunha-Gomes D, Choudhari C, Kavarana NM. Vascular Compromise of the Pectoralis Major Musculocutaneous Flap in Head and Neck Reconstruction. Ann Plast Surg 2003; 51:450-4. [PMID: 14595178 DOI: 10.1097/01.sap.0000095649.87358.b7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In head and neck reconstructive surgery, the pectoralis major musculocutaneous flap is a major reconstructive tool, both in primary as well as secondary reconstructions. In a few cases the authors have been able to demonstrate that when the pectoralis major musculocutaneous flap is translocated to the mouth through a noncompromised neck tunnel, as is done for head and neck reconstructions, the taut lateral pectoral nerve is seen to compress the vascular pedicle of the flap, adversely affecting its vascularity, which can lead to partial or total necrosis of the flap. The authors explain this feature, very specific to this flap, with the help of a prospective series of patients.
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Affiliation(s)
- Dean Cunha-Gomes
- Department of Plastic and Reconstructive Surgery, Bombay Hospital Institute of Medical Sciences, Mumbai, India.
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Talmi YP, Benzaray S, Peleg M, Eyal A, Bedrin L, Shoshani Y, Yahalom R, Horowitz Z, Taicher S, Kronenberg J, Shiner RJ. Pulmonary function after pectoralis major myocutaneous flap harvest. Laryngoscope 2002; 112:467-71. [PMID: 12148856 DOI: 10.1097/00005537-200203000-00012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The pectoralis major myocutaneous flap is widely used in the reconstruction of surgical defects in the head and neck region. Pulmonary atelectasis has been reported in patients undergoing these procedures, and many of these patients are heavy smokers and drinkers and have associated cardiopulmonary disorders. Flap harvest and donor site closure may lead to impairment of pulmonary function before and after the use of pectoralis major myocutaneous (PMC) in surgical reconstruction in patients with cancer of the head and neck. METHODS Patients undergoing extirpation of head and neck tumors with PMC reconstruction were prospectively evaluated. Patient age, smoking history (pack-years), anesthesia duration, percentage predicted pre- and postoperative FEV1, percentage-predicted pre- and postoperative FVC (forced vital capacity), and preoperative SaO2 (oxygen saturation) were evaluated. Preoperative FEV1/FVC ratio was calculated. Chest x-rays were reviewed. RESULTS Only 11 patients, 5 of whom smoked, could be evaluated postoperatively. Preoperative FEV1/FVC was more than 70 and FEV1 more than 75% predicted in all patients. A decrease in FVC was observed in 7 of the 11 patients, which ranged between 2% and 27% without any clinically obvious respiratory manifestations. A baseline SaO2 of more than 96% was noted in all patients. Four of 9 postoperative chest x-rays demonstrated atelectasis. CONCLUSIONS PMC harvest and donor site closure may lead to the recorded decrease in FVC measurements. These changes did not manifest clinically. Nevertheless, alternative methods of surgical defect closure should be considered in patients with severe preexisting pulmonary disorders.
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Affiliation(s)
- Yoav P Talmi
- Department of Otolaryngology--Head and Neck Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel.
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Vendrell Marqués JB, Zapater Latorre E, Ferrandis Perepérez E, Estellés Ferriol E, Brotons Durbán S. [Pedicled pectoralis major musculocutaneous flaps]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2002; 53:39-45. [PMID: 11998517 DOI: 10.1016/s0001-6519(02)78279-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A retrospective series of 76 pedicled pectoralis major musculocutaneus flaps is presented. We used this technique in reconstruction after head and neck tumours resections and in complications of oncological surgery such as pharyngostomes or orostomes. Most of these flaps were used in reconstruction of oral cavity and in postradiotherapy salvaje surgery cases. We also analyse the presence of complications at the donor and receiver sites and its correlation with different parameters like protein levels, haemoglobin, administration of radiotherapy and its dose, previous quimiotherapy and the influence of systemic diseases.
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Affiliation(s)
- J B Vendrell Marqués
- Servicio de Otorrinolaringología, Fundación Instituto Valenciano de Oncología, Valencia
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Bussi M, Ferrero V, Riontino E, Gasparri G, Camandona M, Cortesina G. Problems in reconstructive surgery in the treatment of carcinoma of the hypopharyngoesophageal junction. J Surg Oncol 2000; 74:130-3. [PMID: 10914822 DOI: 10.1002/1096-9098(200006)74:2<130::aid-jso9>3.0.co;2-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES Thirty percent of carcinomas of the pyriform sinus manifest generally with infiltrations in the cervical esophagus. In recent years, progress in reconstructive surgery has broadened surgical indications to include tumors previously managed with palliative measures alone. In some cases, radical surgery has been extended to creating safer resection margins, with more and more indications for circular pharyngectomy. Lesions involving the hypopharyngoesophageal junction pose particular problems; furthermore, the high rate of synchronous or metachronous tumors warrants the indication for total esophagectomy, which requires complex reconstructive techniques. METHODS We report on a series of 21 patients who underwent pharyngocoloplasties after receiving total pharyngolaryngoesophagectomy. RESULTS With regard to the oncologic results, after a follow-up of 2-60 months, 9 patients had no evidence of disease, 5 patients died during the postoperative course, 2 patients survived with disease, 4 died with disease, 1 died from metachronous breast carcinoma, and 7 underwent reintervention. CONCLUSIONS In cases in which reconstruction by gastric pull-up is considered risky, if not contraindicated, pharyngocoloplasty represents a particularly reliable treatment option. The limits and advantages of the technique are discussed. The procedure permitted us to reconstruct the digestive tract, without encountering problems any more serious than those a normal gastric pull-up procedure would pose.
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Affiliation(s)
- M Bussi
- II Otorhinolaryngology Department, University of Turin, Italy
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León X, Quer M, Burgués J. Montgomery salivary bypass tube in the reconstruction of the hypopharynx. Cost-benefit study. Ann Otol Rhinol Laryngol 1999; 108:864-8. [PMID: 10527277 DOI: 10.1177/000348949910800908] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study analyzes the postoperative complications and the functional results in 61 patients who underwent total laryngectomy with partial or total (circumferential) pharyngectomy reconstructed with a pectoralis major myocutaneous flap, in relation to the use of the Montgomery Salivary Bypass Tube (MSBPT). There were no significant differences regarding frequency of postoperative cervical complications in relation to the use of the MSBPT. The median hospital stay for patients without the MSBPT (36 days) was significantly higher than that for patients with the MSBPT (25 days). Although the MSBPT did not modify the rate of complications at the cervical level, it did reduce their severity. A financial study showed the cost-effectiveness of using the MSBPT. Systematic use of the MSBPT is recommended after total laryngectomy with partial or total pharyngectomy reconstructed with a pectoralis major myocutaneous flap.
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Affiliation(s)
- X León
- Department of Otorhinolaryngology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma Barcelona, Spain
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Carvalho AL, Miguel REV, Santos CRD, Magrin J, Gonçalves Filho J, Kowalski LP. Reconstrução total de faringe: análise de 69 casos. Rev Col Bras Cir 1999. [DOI: 10.1590/s0100-69911999000200004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Os autores analisaram retrospectivamente as reconstruções após faringolaringectomias totais e faringolaringo-esofagectomias totais realizadas num período de 18 anos, com o objetivo de comparar os resultados imediatos e tardios das diversas técnicas empregadas. Foram revistos 69 casos submetidos a reconstruções totais de faringe realizadas no Hospital A.C.Camargo, de 1980 a 1997. Hipofaringe e laringe eram os locais da neoplasia em 57 pacientes (82,6%), o esôfago cervical, em sete (10,1 %), e outras localizações em cinco (7,2%). Em 62,4% dos casos, o tumor encontrava-se em estádio avançado, e em 18,8% os pacientes apresentavam recidivas de tumores previamente tratados. As cirurgias consistiram em faringolaringoesofagectomia total e transposição de tubo gástrico (gastric pull-up) em 14 pacientes (20,3%), e com interposição de cólon em cinco (7,3%); e de faringolaringectomia total com reconstrução a partir da rotação de retalho do músculo peitoral maior tubulizado em 16 pacientes (23,2%), com retalho do músculo peitoral maior suturado à fáscia pre-vertebralis em 29 (42,0%) e com outras reconstruções em cinco (7,2%). Das técnicas de reconstrução em faringolaringoesofagectomia, o gastric pull-up apresentou índices menores de complicações e mortalidade pós-operatória. Quando comparamos as reconstruções em faringolaringectomia total, os casos reconstruídos com retalho miocutâneo suturado à fáscia pre-vertebralis apresentaram índices menores de fístula e estenose. No entanto, essas diferenças não foram estatisticamente significativas. Diante destes resultados, nossa conduta em faringolaringectomias totais, quando não é possível a reconstrução da faringe com sutura primária, é realizar a rotação do retalho do músculo peitoral maior suturado à fáscia pre-vertebralis. Quando é necessária a faringolaringoesofagectomia, realizamos reconstrução com gastric pull-up.
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Affiliation(s)
| | | | | | - José Magrin
- Departamento de Cirurgia de Cabeça e Pescoço
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Yinde LAB, Rapoport A, Fava AS, Andrade Sobrinho JD, Denardin OVP, Carvalho MBD. Limitações da viabilidade do retalho miocutâneo de músculo grande peitoral em cabeça e pescoço: estudo de 72 casos. Rev Col Bras Cir 1999. [DOI: 10.1590/s0100-69911999000200002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O emprego do retalho miocutâneo do músculo peitoral maior é rotina nos procedimentos reconstrutivos no tratamento das neoplasias das vias aerodigestivas superiores nos estádios III e IV. Assim, no Serviço de Cirurgia de Cabeça e Pescoço do Hospital Heliópolis, de 1983 a 1994, a utilização deste retalho foi necessária em 66 pacientes portadores de carcinoma epidermóide e em seis com outras neoplasias malignas. Quanto à localização, as lesões acometiam a cavidade oral em trinta pacientes (41,6%), a hipofaringe em 16 pacientes (22,2%), tegumentos em 13 pacientes (18,0%), a orofaringe em dez pacientes (13,8), a laringe em dois pacientes (2,7%), a rinofaringe em um paciente (1,3%). Para a reconstrução foram empregados 72 retalhos, sendo que em 49 casos (68,0%) ocorreram complicações, enquanto que, em 23 pacientes, houve evolução sem a ocorrência das mesmas. Do grupo de pacientes que evoluíram com complicações, em 45 deles (91,2%) não houve necessidade de procedimentos complementares. Quanto às complicações, tivemos 18 necroses parciais (27,2%), 34 deiscências parciais (51,5%), 28 fístulas (42,4%), 34 infecções (51,5%) e dois hematomas (3,0%), sendo na grande maioria dos casos concomitantes (X2 = 20; p=0,22). Quanto aos 49 pacientes que apresentaram complicações, três eram portadores de neoplasias malignas do estádio clínico III e 46 do estádio IV (x2=2; p=0,15), sendo que, em 70,6% dos casos, o tratamento radioterápico já havia sido indicado previamente (Teste de Fisher: p=0,0785). Concluem os autores que, como fatores de risco para o aparecimento de complicações, os níveis séricos de a1bumina abaixo de 3,5g% e hemoglobina 12mg% foram aqueles com significado estatístico (respectivamente p=0,0048 e 0,0037).
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Brown MR, McCulloch TM, Funk GF, Graham SM, Hoffman HT. Resource utilization and patient morbidity in head and neck reconstruction. Laryngoscope 1997; 107:1028-31. [PMID: 9261002 DOI: 10.1097/00005537-199708000-00004] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Many papers have addressed the technical aspects of free tissue transfer in head and neck cancer patients. However, there has not been a critical assessment of the impact of free tissue transfer on resource utilization and patient morbidity compared with pedicle flap reconstructions. Two cohorts of patients derived from 245 consecutive reconstructions were tightly matched by age, site, stage, and histology, yielding 44 patient pairs differing in method of reconstruction. Patients undergoing free flap reconstruction spent more time in the operating room than those reconstructed with pedicled flaps (993 min vs. 777 min, P < 0.0001). The group with free flap reconstruction spent fewer days in the surgical intensive care unit and hospital (2 days vs. 2.5 days; 18.5 days vs. 22.6 days). This difference is attributed to the paucity of postoperative complications in the group with free flap reconstruction (fistula formation 4.5% vs. 21%, P < 0.04). These data indicate that the continued use of sophisticated reconstructive techniques in head and neck cancer patients is economically sound as assessed by patient morbidity and resource utilization.
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Affiliation(s)
- M R Brown
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, 52242, U.S.A
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Stack BC, Klotch DW, Hubbell DS. Costal osteomyelitis after pectoralis major myocutaneous flap use in head and neck reconstruction. Am J Otolaryngol 1995; 16:78-80. [PMID: 7717478 DOI: 10.1016/0196-0709(95)90014-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Costal osteomyelitis and chondritis are rare complications of PMMF usage. They probably represent a secondary complication of a donor-site infection. This diagnosis must be considered in cases of PMMF donor-site infections, which fail to resolve with local wound care and antibiotics. Antibiotic coverage in these cases should be taylored to culture results, while having broad gram-positive activity. Workup of these patients should include CT and biopsy to rule out a neoplastic process.
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Affiliation(s)
- B C Stack
- Division of Otolaryngology-Head and Neck Surgery, University of South Florida College of Medicine, Tampa, USA
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