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Nandy K, Jayaprakash D, Bhatt S, Mithi M, Kumar P, Rathod P. Bilobed Pectoralis Major Myocutaneous Flap Reconstruction: a Single Institution Experience of 150 Patients and Methods to Prevent Complications. J Maxillofac Oral Surg 2024; 23:248-257. [PMID: 38601219 PMCID: PMC11001805 DOI: 10.1007/s12663-020-01485-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 11/21/2020] [Indexed: 10/22/2022] Open
Abstract
Introduction Bilobed PMMC flap is done for patients who have diseases that require resection of oral cavity mucosa along with the overlying skin, either because of direct tumor invasion to the skin or for achieving adequate tumor-free base of resection. The versatility of the flap allows it to be used to cover both inner and outer linings for a full-thickness defect. Materials and Methods This was a single-center, retrospective, observational study carried out in the Department of Head and Neck Oncology at a regional cancer center from January 2019 to December 2019. A minimum follow-up duration for all patients was 6 months. The primary endpoint was to study the results and complications associated with bilobed PMMC flap reconstruction and factors affecting it, as well as their management. Results The median age was 45 years [24-71 years]. There were 96(64%) males and 54(36%) females. The most common sites reconstructed were lower gingivobuccal sulcus (39.1%), buccal mucosa (30.2%), and lower alveolus (16.7%). The overall complication rate was 41.3%, with 10(6.6%) patients requiring re-exploration. The average hospital stay was 11 days [5-28 days]. On doing a multivariate analysis, for various factors affecting flap necrosis, none of the factors reached statistical significance (p value > 0.05). Conclusion PMMC flap remains the workhorse of head and neck reconstruction. In cases of full-thickness defects in oral cancer patients, in our country, in the setup which lacks the expertise in microvascular anastomosis and with immense caseload in the head and neck cancer department, bilobed PMMC flap remains a safe and favorite alternative method for reconstruction.
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Affiliation(s)
- Kunal Nandy
- Department Of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat India
| | - Dipin Jayaprakash
- Department Of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat India
| | - Supreet Bhatt
- Department Of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat India
| | - Mohamad Mithi
- Department Of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat India
| | - Prachur Kumar
- K.M. Shah Dental College, Sumandeep Vidyapeeth Piparia, Vadodara, Gujarat India
| | - Priyank Rathod
- Department Of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat India
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Gora BS, Sharma S, Patel P, Lakhera KK, Singh S, Babu A, Singhal PM, Agarwal NK. Bipaddle Pectoralis Major Myocutaneous Flap (PMMC) for Complex Composite Oral Cavity Defects: An Experience of a Tertiary Cancer Centre. Indian J Otolaryngol Head Neck Surg 2024; 76:336-343. [PMID: 38440573 PMCID: PMC10908753 DOI: 10.1007/s12070-023-04159-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 08/19/2023] [Indexed: 03/06/2024] Open
Abstract
Although microvascular free flaps are considered the first choice in head and neck cancer defect reconstruction, their use is limited in developing regions by availability of resources and the expertise .The Bipaddle pectoralis major myocutaneous flap (PMMC flap) is a commonly used flap in head and neck cancer reconstruction, but in literature flap is associated with high incidence of drawbacks including donor site morbidity and added bulk of the flap reducing cosmetics and function. The purpose of the study is to evaluate the Bipaddle PMMC flap reliability, operative technique and outcome in reconstructive head and neck cancer surgery in the era of microvascular free flaps. Its a prospective study in which the records of 50 patients treated with Bippadle PMMC flap reconstruction between January 2022 to July 2022 were systematically collected and reviewed. Data of recipient site, serum albumin, history of adjuvant, recurrence, defect dimension, type of donor site closure, length of hospital stay, postoperative complications and outcomes were analysed. There were 45 males and 5 females with a mean age of 41 years (31-60). Bipaddle PMMC flap reconstruction was done in all patients of advanced squamous cell carcinoma of oral cavity. There were two males with complete necrosis of flap salvaged with latissimus dorsi flap and forehead flap. Minor infections were noted in two female and one male patient, managed conservatively and recovered well with acceptable final outcome. The Bipaddle PMMC flap is reliable for large defects in head and neck reconstructive surgery, particularly when a bulky flap is required to reconstruct composite defects where the lesion is involving the skin. Placing the flap horizontally with inclusion of nipple and areola in most of the patients increased the reach and size of available flap.
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Affiliation(s)
- Bhoopendra Singh Gora
- Department of Surgical Oncology, Sawai Man Singh Medical College and attached Hospitals, Jaipur, Rajasthan 302004 India
| | - Shubhra Sharma
- Department of Surgical Oncology, Sawai Man Singh Medical College and attached Hospitals, Jaipur, Rajasthan 302004 India
| | - Pinakin Patel
- Department of Surgical Oncology, Sawai Man Singh Medical College and attached Hospitals, Jaipur, Rajasthan 302004 India
| | - Kamal Kishor Lakhera
- Department of Surgical Oncology, Sawai Man Singh Medical College and attached Hospitals, Jaipur, Rajasthan 302004 India
| | - Suresh Singh
- Department of Surgical Oncology, Sawai Man Singh Medical College and attached Hospitals, Jaipur, Rajasthan 302004 India
| | - Agil Babu
- Department of Surgical Oncology, Sawai Man Singh Medical College and attached Hospitals, Jaipur, Rajasthan 302004 India
| | - Pranav Mohan Singhal
- Department of Surgical Oncology, Sawai Man Singh Medical College and attached Hospitals, Jaipur, Rajasthan 302004 India
| | - Naina Kumar Agarwal
- Department of Surgical Oncology, Sawai Man Singh Medical College and attached Hospitals, Jaipur, Rajasthan 302004 India
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Singhal PM, Patel P, Lakhera KK, Babu A, Chatterjee A, Singh S, Gora BS, Agarwal NK. Can Lateral Thoracic Artery Preservation Improve Results in Large PMMC Flaps? - Our Experience of 61 Cases from Northern India. Indian J Otolaryngol Head Neck Surg 2024; 76:182-190. [PMID: 38440499 PMCID: PMC10909003 DOI: 10.1007/s12070-023-04123-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/27/2023] [Indexed: 03/06/2024] Open
Abstract
Introduction: Pectoralis major myo-cutaneous (PMMC) flap continues to be a widely used tool to reconstruct oral cavity defects. But an unreliable and unstable vascular supply can lead to complications like flap loss, Oro-cutaneous fistula and wound dehiscence. Preservation of the lateral thoracic artery (LTA) has been suggested to improve the vascularity of the skin paddle. The present study aspires to compare the complications and flap related outcomes after preserving or sacrificing the LTA while reconstructing oral cavity defects with bi-folded PMMC flap. Materials and Methods: Retrospective analysis of the data of 61 male patients who were reconstructed with bi-folded PMMC flaps between January 2022 and September 2022 was done. 36 patients were reconstructed using a PMMC flap where the LTA was sacrificed, whereas in 25 patients the LTA was preserved. Data was analyzed in terms of patient factors and flap related complications. Results: The overall complication rate including major/minor complications was 44.26% with flap detachment at 22.95% being the commonest complication observed. 13.11% patients developed an Oro-cutaneous fistula and partial and complete flap loss were seen in 9.83% and 4.91% respectively. LTA preservation was significantly associated with only decreased flap detachment rates (p value < 0.05). No significant association was noticed between other flap related complications and LTA preservation. Conclusion: Reconstructing larger defects with a PMMC flap where the LTA is preserved can help improve the vascularity of the flap and decrease various major/minor flap related complications. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-04123-3.
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Affiliation(s)
| | | | | | - Agil Babu
- SMS Medical College, Jaipur, Rajasthan India
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4
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Singh AK, J F N, Sharma NK, Anandkumar J, Mishra N, Pandey A. Bipaddled Pectoralis Major Myocutaneous Flap in Complex Oral Cancer Defects- A Single Center Experience with Quality of Life Assessment. Indian J Otolaryngol Head Neck Surg 2023; 75:641-648. [PMID: 37274991 PMCID: PMC10235259 DOI: 10.1007/s12070-022-03324-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Advanced stage malignancies of oral cavity commonly result in complex full thickness defects with subsequent functional and aesthetic loss. Through this article we describe our center's experience in reconstruction of such defects with bipaddled pectoralis myocutaneous (PMMC) flap through an immediate, single-staged procedure. Materials And Methods The study included a total of 54 patients who underwent composite resection and neck dissection followed by reconstruction of the defect with bipaddled PMMC flap. All patients were followed up post-operatively for 1 year and were monitored for flap and donor site related complications. Using University of Washington Quality of life v4 questionnaire (UW-QOL4), we assessed the QOL of 54 patients. The mean scores were compared to other similar studies. Results: The overall complication rate was 66.6%, whereas, 33.3% patients had no complications. The most common complication was wound dehiscence seen in 31.5% of cases in the recipient site and 12.9% in the donor site. Other complications were seroma, hematoma, plate exposure, orocutaneous fistula etc. Around 73.7% patients reported a good, very good or outstanding overall quality of life in the post-operative period. The mean composite QOL score was 65.84. Our study showed comparable domains of pain, appearance, activity, recreation, swallowing, chewing, speech, shoulder function and taste with other similar studies. Conclusion: Bipaddled PMMC flap proves to be a considerable alternative for microvascular free flaps in reconstruction of full-thickness defects of oral cavity owing to its reliable blood supply, accessibility, easier harvesting technique, cost effectiveness, high success rate and acceptable quality of life. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-022-03324-6.
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Affiliation(s)
- Akhilesh Kumar Singh
- Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P India
| | - Neville J F
- Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P India
| | - Naresh Kumar Sharma
- Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P India
| | - Janani Anandkumar
- Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P India
| | - Nitesh Mishra
- Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P India
| | - Arun Pandey
- Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P India
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Kang SK, Qamar SN, Khan IM, Crosbie R, Tikka T. 10-Year Experience with the Modified Pectoralis Major Flap: The Use of the Deltopectoral Flap to Reduce Skin Tension. Indian J Otolaryngol Head Neck Surg 2022:1-8. [PMCID: PMC9641681 DOI: 10.1007/s12070-022-03154-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 09/03/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Swee Keong Kang
- Department of Otolaryngology head & neck surgery, University Hospital Monklands, ML6 0JS Airdrie, Scotland, UK
| | - Sabih Nadeem Qamar
- Department of Otolaryngology head & neck surgery, University Hospital Monklands, ML6 0JS Airdrie, Scotland, UK
| | - Imran Mohib Khan
- Department of Otolaryngology head & neck surgery, University Hospital Monklands, ML6 0JS Airdrie, Scotland, UK
| | - Robin Crosbie
- Department of Otolaryngology head & neck surgery, University Hospital Monklands, ML6 0JS Airdrie, Scotland, UK
| | - Theofano Tikka
- Department of Otolaryngology head & neck surgery, University Hospital Monklands, ML6 0JS Airdrie, Scotland, UK
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Matos LL, da Silva JB. Potential application of human SALL4 on oral squamous cell carcinoma. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:919. [PMID: 36172107 PMCID: PMC9511190 DOI: 10.21037/atm-22-3982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Leandro Luongo Matos
- Head and Neck Surgery, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (Icesp, HCFMUSP), São Paulo, Brazil.,Surgical Clinic, Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Sharma AP, Malik J, Monga S, Alam S, Rasool S, Agarwal D, Bahadur S. Analysis of the efficacy of the pectoralis major myocutaneous flap in reconstructive head and neck surgery. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022; 73:151-156. [DOI: 10.1016/j.otoeng.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 11/21/2020] [Indexed: 11/28/2022]
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8
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Sharma AP, Malik J, Monga S, Alam S, Rasool S, Agarwal D, Bahadur S. Analysis of the efficacy of the pectoralis major myocutaneous flap in reconstructive head and neck surgery. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021; 73:S0001-6519(20)30202-8. [PMID: 33485625 DOI: 10.1016/j.otorri.2020.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/10/2020] [Accepted: 11/21/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Although free flaps have been used predominantly in past decades for the soft tissue reconstruction of head and neck malignancies, Pectoralis major myocutaneous flap (PMMF) is still a reliable workhorse for patients with co-existing co-morbidities or low economic status where free flaps are not feasible. PATIENTS AND METHODS It was a retrospective study done on 36 patients of head and neck malignancies over the period of 5 years in which PMMF was used as a method of reconstruction in our hospital. Patients were followed up for a period of one year and outcome of PMMF was evaluated. RESULTS Out of 36 patients 31 were of oral cancer and 5 were of carcinoma hypopharynx. Incidence of total flap necrosis was nil and partial flap necrosis was 16.6%. Orocutaneous fistula was found in 16.6%, wound dehiscence was in 19.4% and infection was found in 13.5% of patients. Non-flap related complications were found in 13.8% of patients. 35 out of 36 patients (97.2%) eventually achieved satisfactory surgical outcome of PMMF reconstruction. CONCLUSION PMMF is a reliable method of reconstruction for head and neck malignancies especially in basic healthcare settings. With minimal expertise and groundwork, it is still a cost-effective workhorse flap for head and neck reconstruction.
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Affiliation(s)
- Arun Parkash Sharma
- Department of Otorhinolaryngology and Head & Neck Surgery, Hamdard Institute of Medical Sciences & Research and HAHC Hospital, Jamia Hamdard University, Hamdard Nagar, Delhi, India
| | - Junaid Malik
- Department of Otorhinolaryngology and Head & Neck Surgery, Hamdard Institute of Medical Sciences & Research and HAHC Hospital, Jamia Hamdard University, Hamdard Nagar, Delhi, India
| | - Seema Monga
- Department of Otorhinolaryngology and Head & Neck Surgery, Hamdard Institute of Medical Sciences & Research and HAHC Hospital, Jamia Hamdard University, Hamdard Nagar, Delhi, India.
| | - Shamsheer Alam
- Department of Otorhinolaryngology and Head & Neck Surgery, Hamdard Institute of Medical Sciences & Research and HAHC Hospital, Jamia Hamdard University, Hamdard Nagar, Delhi, India
| | - Shahid Rasool
- Department of Otorhinolaryngology and Head & Neck Surgery, Hamdard Institute of Medical Sciences & Research and HAHC Hospital, Jamia Hamdard University, Hamdard Nagar, Delhi, India
| | - Deepti Agarwal
- Department of Otorhinolaryngology and Head & Neck Surgery, Hamdard Institute of Medical Sciences & Research and HAHC Hospital, Jamia Hamdard University, Hamdard Nagar, Delhi, India
| | - Sudhir Bahadur
- Department of Otorhinolaryngology and Head & Neck Surgery, Hamdard Institute of Medical Sciences & Research and HAHC Hospital, Jamia Hamdard University, Hamdard Nagar, Delhi, India
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9
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Giovacchini F, Bensi C, Paradiso D, Docimo R, Tullio A. Association between blood transfusions and complications in head and neck reconstruction: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2020; 278:2171-2185. [PMID: 32870364 DOI: 10.1007/s00405-020-06286-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/10/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this meta-analysis is to assess the correlation between blood transfusions and the medical/surgical complications after head and neck reconstructive surgery. METHODS The PRISMA protocol was used and the literature search was performed on Pubmed, Scopus, Cochrane Library and Web of Science up to March 13, 2020. The risk of bias in individual studies was assessed through the Newcastle Ottawa Scale. RESULTS A total of 1219 records were screened after the electronic search, 22 of which were included in the qualitative analysis. Of there 22 scores, 18 articles were included in the meta-analysis. The OR for medical and surgical complications of transfused patients was 1,64 (95% CI 1.23-2.21); while, the OR for hospital readmission was 1.53 (95% CI 1.29-1.81). CONCLUSIONS The results of this meta-analysis suggested that blood transfusions are associated with both an increased risk of surgical and medical complications of head and neck flaps and with the hospital readmission.
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Affiliation(s)
- Francesco Giovacchini
- Maxillo-Facial Surgery Unit, Santa Maria Della Misericordia Hospital, Piazza Menghini 1, San Sisto, Perugia, Italy
| | - Caterina Bensi
- Paediatric Dentistry Post-Graduate School, University of Rome "Tor Vergata", Via Montpellier 1, Rome, Italy.
| | - Daniele Paradiso
- S.S.D. of Oral Surgery and Ambulatory, Santa Maria Della Misericordia Hospital, Piazza Menghini 1, San Sisto, Perugia, Italy
| | - Raffaella Docimo
- Paediatric Dentistry, Department of Surgical Sciences, University of Rome "Tor Vergata", Via Montpellier 1, Rome, Italy
| | - Antonio Tullio
- Maxillo-Facial Surgery, University of Perugia, Perugia, Italy
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Sallustro M, Abualhin M, Faggioli G, Pilato A, Dall'Olio D, Simonetti L, Astarita F, Amorosa L, Gargiulo M. Multistep and Multidisciplinary Management for Post-irradiated Carotid Blowout Syndrome in a Young Patient With Oropharyngeal Carcinoma: A Case Report. Ann Vasc Surg 2020; 67:565.e1-565.e5. [PMID: 32209410 DOI: 10.1016/j.avsg.2020.02.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/08/2020] [Accepted: 02/16/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Carotid blowout syndrome is a severe complication of head and neck cancer, associated with high mortality and morbidity. METHODS We present a case of acute hemorrhage from the carotid artery of a 59-year-old man with a history of chemoradiotherapy for lingual base and oropharyngeal squamous cell carcinoma. The case was managed by a staged multidisciplinary approach of open arterial reconstruction, after initial endovascular hemorrhage control using stent graft. RESULTS The patient was discharged to home with patent carotid artery, no sign of infection or bleeding, and autonomous ambulation. A CT/PET scan performed 6 months later confirmed healing and absence of tumor recurrence. CONCLUSIONS A multidisciplinary approach involving vascular surgeons, ENT surgeons, plastic and maxillofacial surgeons is particularly appropriate in the management of carotid blowout syndrome to warrant a durable and effective repair of all the anatomical structures involved.
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Affiliation(s)
- Marianna Sallustro
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, DIMES, University of Bologna, Policlinico Sant'Orsola- Malpighi, Bologna, Italy.
| | - Mohammad Abualhin
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, DIMES, University of Bologna, Policlinico Sant'Orsola- Malpighi, Bologna, Italy
| | - GianLuca Faggioli
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, DIMES, University of Bologna, Policlinico Sant'Orsola- Malpighi, Bologna, Italy
| | - Alessandro Pilato
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, DIMES, University of Bologna, Policlinico Sant'Orsola- Malpighi, Bologna, Italy
| | - Danilo Dall'Olio
- Department of Otorhinolaryngology, Maggiore Hospital, Azienda AUSL, Bologna, Italy
| | - Luigi Simonetti
- Interventional and Urgency Radiology and Neuroradiology Unit, Maggiore Hospital, Bologna, Italy
| | - Fabio Astarita
- Department of Otorhinolaryngology, Maggiore Hospital, Azienda AUSL, Bologna, Italy
| | - Luca Amorosa
- Department of Maxillofacial Surgery, Maggiore Hospital, Azienda AUSL, Bologna, Italy
| | - Mauro Gargiulo
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, DIMES, University of Bologna, Policlinico Sant'Orsola- Malpighi, Bologna, Italy
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11
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Lakshminarayana G, Venkitachalam S, Mani CS. Choice of Regional Flaps for Oral Cancer Defects: Relevance in Current Era. J Maxillofac Oral Surg 2019; 20:246-251. [PMID: 33927493 DOI: 10.1007/s12663-019-01305-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 11/12/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction Microvascular free flaps (MVFF) are the current standard of care for reconstruction of oral ablative defects; however, pedicled myocutaneous flaps (PMCF) are still used widely in India. The rationale behind the preference for selecting PMCF in the present era is not well understood. The associated complications and swallowing outcomes are variable. Methods We retrospectively analysed the records of patients who underwent reconstructive surgery for oral cancer ablative defects over a 3-year period. Results Ninety-seven pedicled myocutaneous flaps [89 pectoralis major myocutaneous (PMMC) flaps, eight lower trapezius island myocutaneous (TMC) flaps] and 113 MVFFs were performed. The reasons for selecting PMCF were financial constraints 38.7%, MVFF salvage 22.5%, medically compromised 10.7%, vessel-depleted neck 6.4%, old age with PS2 + 5.3%, early recurrence 5.3%, borderline resectable 4.3%, palliative resection 2.1%. Overall complication rate was 20.4%. Of patients, 50.7% and 34.7% were on regular and semisolid diet, respectively; 66.6% had acceptable swallowing-related social well-being. Conclusion PMCFs have an important role in developing countries with patients having financial constraints. The other potential reasons driven by patient factors were discussed. The swallowing outcomes are good, with majority of the people having socially acceptable swallowing function.
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Affiliation(s)
- G Lakshminarayana
- Cancer Research and Relief Trust, C/o Kumaran Hospital, No. 214, EVR Periyar Salai, Kilpauk, Chennai, Tamil Nadu 600010 India
| | - Shruti Venkitachalam
- Cancer Research and Relief Trust, C/o Kumaran Hospital, No. 214, EVR Periyar Salai, Kilpauk, Chennai, Tamil Nadu 600010 India
| | - C S Mani
- Cancer Research and Relief Trust, C/o Kumaran Hospital, No. 214, EVR Periyar Salai, Kilpauk, Chennai, Tamil Nadu 600010 India
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12
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Davudov MM, Rahimov C, Fathi H, Mirzajani Z, Aliyeva M. The Use of Pectoralis Major Musculocutaneus and Deltopectoral Flaps in Oromandibular Defects Reconstruction. World J Plast Surg 2019; 8:401-405. [PMID: 31620345 PMCID: PMC6790250 DOI: 10.29252/wjps.8.3.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The main complication in patients with combined treatment of head, neck, mandibular and maxillary tumors is osteoradionecrosis, which appears after radiation therapy. Radiation therapy is widely used to treat cancer, but growing concern is related to the risk of osteoradionecrosis after treatment. This can occur after radiation therapy. Below, we would like to describe the treatment of osteoradionecrosis, which appeared 5 years after radiation therapy in a 54-year-old male patient. In 2012, a patient in Turkey was diagnosed with adenocystic carcinoma of the tongue base, and surgery was performed to remove the tumor after the patient underwent a course of radiotherapy. In 2016, the patient underwent again a surgery for tumor recurrence. In December 2017, the patient was admitted to our clinic with osteoradionecrosis. We performed segmental resection of the mandible, type I right-sided modified neck dissection, reconstruction of the mandible with a titanium plate and a pectoralis major muscle skin flap. The technique described in this case is the insertion of a well-vascularized tissue into the pre-irradiated and necrotic hypovascular region of the mandible with a skin-muscle flap of the pectoralis major muscle wrapped around the plate for reconstruction. As a result, a pectoralis major flap coverred the mouth floor on internal side and the outside skin defect was covered with a deltopectoral one. The viability of the skin-muscle flap of the pectoralis major muscle was assessed using clinical monitoring, checking the flap every four hours for the first 3 days. This study describes a successful outcome.
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Affiliation(s)
- Mahammad M Davudov
- Department of Oral and Maxillofacial Surgery, Azerbaijan Medical University, Baku, Azerbaijan.,Department of Aesthetic, Plastic and Reconstructive Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Chingiz Rahimov
- Department of Oral and Maxillofacial Surgery, Azerbaijan Medical University, Baku, Azerbaijan
| | - Hamidreza Fathi
- Department of Aesthetic, Plastic and Reconstructive Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Zoheyr Mirzajani
- Department of Oral and Maxillofacial Surgery, Azerbaijan Medical University, Baku, Azerbaijan.,Department of Aesthetic, Plastic and Reconstructive Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mirvari Aliyeva
- Department of Oral and Maxillofacial Surgery, Azerbaijan Medical University, Baku, Azerbaijan
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13
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Risk Factors for Surgical Site Infection in Patients Undergoing Free and Pedicled Myocutaneous Flap Reconstruction After Oral Cancer Resection. J Oral Maxillofac Surg 2019; 77:1075-1081. [DOI: 10.1016/j.joms.2018.12.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 12/25/2018] [Accepted: 12/25/2018] [Indexed: 01/16/2023]
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14
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Anehosur V, Dikhit PS, Nagraj N, Jayade B, Kumar N. PMMC Flap Revisited and its Clinical Outcome in 150 Patients. J Maxillofac Oral Surg 2019; 19:26-31. [PMID: 31988559 DOI: 10.1007/s12663-019-01228-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 04/11/2019] [Indexed: 10/27/2022] Open
Abstract
Introduction Pectoralis myocutaneous flap remains the workhorse for the reconstruction of large defects in the head and neck region despite free flaps gaining popularity; because of its drawbacks such as long operating hours, high cost and special skill techniques, it is not used in most of the institutions. Even in our institution, free tissue transfers are carried out on a regular basis, but there is a definite scope and role for PMMC flap in reconstruction. We present our experience with pectoralis major myocutaneous flap in terms of postoperative complications, donor site morbidity, flap survival and long-term healing of the flap. Materials and methods In this study, 150 patients who underwent pectoralis myocutaneous flap reconstruction from 2008 to 2016 were analysed for postoperative complications like donor site morbidity, flap survival and long-term healing of the flap. Results On analysis of our data, it was found that the most common complication was wound dehiscence, which was seen in 25 patients(16%), followed by orocutaneous fistula in 15 (10%), wound infection and partial skin margin necrosis, which was seen in a maximum of 12 each(8%), hematoma in 5 (3%), and donor site wound dehiscence in 5 (3%), and there was no case of total flap failure or carotid blowout. Discussion We conclude that PMMC flap along with its modifications is the most cost-effective and associated with least complications.
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Affiliation(s)
- Venkatesh Anehosur
- 1Department of Oral and Maxillofacial Surgery, SDM Craniofacial Research Centre, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka 580009 India
| | - Punit S Dikhit
- 2AIIMS, Bhubaneshwar, India.,3Kidwai Memorial Institute of Oncology, Bangalore, India
| | - Nikhil Nagraj
- 1Department of Oral and Maxillofacial Surgery, SDM Craniofacial Research Centre, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka 580009 India
| | - Bhushan Jayade
- 1Department of Oral and Maxillofacial Surgery, SDM Craniofacial Research Centre, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka 580009 India
| | - Niranjan Kumar
- 4Department of Plastic and Reconstructive Surgery, SDM Craniofacial Research Centre, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka 580009 India
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Wei W, Qiu Y, Fang Q, Jia Y. Pectoralis major myocutaneous flap in salvage reconstruction following free flap failure in head and neck cancer surgery. J Int Med Res 2018; 47:76-83. [PMID: 30514138 PMCID: PMC6384490 DOI: 10.1177/0300060518795530] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective This study aimed to compare the results of the pectoralis major myocutaneous (PMM) flap in primary and salvage head and neck cancer surgery. Methods A total of 160 patients were enrolled in this study. The salvage group consisted of 30 patients who received immediate PMM flap surgery following free flap failure. In the primary group, the PMM flap was primarily chosen for 130 patients. Related information was collected and analysed. The University of Washington (UW)-Quality of Life questionnaire, version 4, was mailed to every patient. Results Partial necrosis was significantly lower in the primary group (n = 13, 10.0%) than in the salvage group (n = 7, 23.3%). Surgical site infection was found in 10 (7.8%) patients in the primary group and in six (20.0%) patients in the salvage group. The mean composite quality of life scores were 66.8 ± 20.5 and 66.2 ± 22.1 in the two groups, respectively. Differences in scores for domains of activity, mood, and anxiety were significant. Disease-specific survival and recurrence-free survival rates were not different between the two groups. Conclusion PMM flap salvage reconstruction has a higher complication rate and poorer functional results, but similar survival prognosis, compared with primary surgery.
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Affiliation(s)
- Wei Wei
- 1 Department of Anesthesia, Children's Hospital Affiliated to Zhengzhou University, Henan provincial key laboratory of children's genetics and metabolic diseases Zhengzhou Children's Hospital, China
| | - Yongsheng Qiu
- 2 Department of Anesthesia, Affiliated Children's Hospital of Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Qigen Fang
- 3 Department of Head and Neck, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Yingping Jia
- 1 Department of Anesthesia, Children's Hospital Affiliated to Zhengzhou University, Henan provincial key laboratory of children's genetics and metabolic diseases Zhengzhou Children's Hospital, China
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Sen S, Gajagowni JG, Pandey JK, Dasgupta P, Sahni A, Gupta S, Mp S, Ravi B. Effectiveness of pectoralis major myocutaneous flap in the surgical management of oral cancer: A retrospective study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 120:21-27. [PMID: 30125737 DOI: 10.1016/j.jormas.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/30/2018] [Accepted: 08/10/2018] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Over 80,000 oral cancer cases get diagnosed each year in India, majority undergoing extensive resections owing to their late presentation. Pectoralis major myocutaneous (PMMC) flap is a pedicled axial pattern flap which is based on thoracoacromical artery. It is readily available as a viable alternative to free flap reconstruction, especially for the economically poor and malnourished patients. Its proximity to head and neck structures gives added advantage to reconstruct complex and large volume oral and maxillofacial defects. It provides a relatively good possibility of functional and aesthetic restoration providing both mucosal lining and skin cover. MATERIALS AND METHODS This was a prospective observational study of 29 PMMC flap reconstructions, conducted between 2013-2016. The reconstruction outcomes assessed in this study were divided into two categories namely "success" and "failure" based on certain functional parameters observed during follow-up of 1 year. The complications were broadly classified as major/minor and flap related/non-flap related. We assessed the feasibility of using a PMMC flap for reconstructing various subsites of oral cavity cancer. Further, the association of patient variables with complication rates and outcome of reconstruction were analysed. RESULTS Out of 29 patients overall complications were noted in 15 (51.7%) cases with a female preponderance. Flap-related complications were noted in 9 whereas non-flap-related complications were seen in 6 patients. Major and minor complications were noted in 2 (both flap related) and 13 cases respectively. Complete full thickness flap necrosis was not encountered in any patient. Patients with flap skin paddle size ≤ 36 cm2 (n = 12) had significantly increased overall complication rates. Despite complications a high success rate (93.1%, n = 27) was achieved with this mode of reconstruction. CONCLUSION The PMMC flap reconstruction is a versatile, reliable and an affordable single staged procedure with a high success rate in terms of achieving treatment goals. Although it has moderately high complication rates, but PMMC flap proved to be a workhorse in locally advanced cases of head and neck cancer at the end of 1 year follow-up.
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Affiliation(s)
- S Sen
- Unit III, Department of Surgical Oncology, Chittaranjan National Cancer Institute, 700026 Kolkata, West Bengal, India.
| | - J G Gajagowni
- Department of Surgical Oncology and Robotic Surgery, Yashoda Hospitals, Secunderabad, India
| | - J K Pandey
- Department of Surgical oncology, AIIMS, Patna, Bihar, India
| | | | - A Sahni
- Max Superspeciality Hospitals, New Delhi, India
| | - S Gupta
- SSKM Hospital, Kolkata, India
| | - S Mp
- Mangalore, Karnataka, India
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MENEZES MARCELOBENEDITO, SALEH KASSEMSAMIR, NAKAI MARIANNEYUMI, DIAS LUCASPORTOMAURITY, KAVABATA NORBERTOKODI, GONÇALVES ANTÔNIOJOSÉ. Pectoralis major myocutaneous flap in Head And Neck Surgery reconstructions: critical analysis. Rev Col Bras Cir 2018; 45:e1682. [DOI: 10.1590/0100-6991e-20181682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 01/25/2018] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to evaluate the results of the use of the pectoralis major flap in the reconstruction of head and neck surgeries. Methods: we conducted a retrospective study with data bank analysis and review of medical records of patients with head and neck cancer operated at the Discipline of Head and Neck Surgery, Surgery Department, São Paulo Holy Home of Mercy, using the pectoralis major flap for reconstruction, in a period of 16 years. We analyzed age, gender, primary site of neoplasia, clinical staging, preoperative radiotherapy (RT) and complications, classified as major and minor. Results: the series comprised 92 patients, of whom 86 (93.5%) were men; the mean age was 61.39 (±11.35) years; the most common primary sites were the mouth, in 35 cases (38%), oropharynx, in 21 (22.8%), and larynx, in 18 cases (19.6%). The majority of patients were in stage IV (88/92, 95.6%) and only four (4.3%) had preoperative RT. The overall complication rate was 48.9%, but only 6.5%, characterized as major complications. In the univariate statistical analysis, we found no factors related to the occurrence of complications. Only the primary neoplasm site presented marginal significance (p = 0.06). Conclusion: the pectoralis major flap is safe, with few complete and effective losses in reconstructions in head and neck surgeries, with low rates of major complications, being an option to be considered.
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Reliability of the pectoralis major myocutaneous flap in reconstructive oral cancer surgery in developing countries: Our experience. Med J Armed Forces India 2016; 72:S1-S7. [PMID: 28050062 DOI: 10.1016/j.mjafi.2016.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 02/28/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although free flaps are nowadays considered 'Gold standard' of head and neck reconstruction, pectoralis major myocutaneous (PMMC) flap is still popular among many reconstructive cancer surgeons in developing countries for its many advantages and also due to lack of resources for free flaps in most of the centers, large number of cancer patients with poor nutritional status and economic condition. However, many studies have reported high complication rate in PMMC flap. So, the purpose of our study was to evaluate the reliability of PMMC flap. METHODS Within a span of 2 years, 20 reconstructions were done with PMMC flaps in patients with oral cancer and they were followed for a period of 1 year. Documentation was done for patient demographics, site of lesion, duration for reconstruction, occurrence of complications, etc. RESULT Among 17 males and 3 female patients, complications developed in 4 males and all female patients (total 7 patients, overall 35%). Flap-related complications were - one major (5%) and six minor (30%), which were comprised of three orocutaneous fistula (15%), three partial flap loss (15%), two marginal necrosis (10%), and one donor site necrosis (5%). Total necrosis was nil in our study. All the complications were managed conservatively except the patient with major complication which required intervention. Final cosmetic and functional outcome was acceptable in majority of patients. CONCLUSION PMMC flap is still 'workhorse' of reconstruction in head neck cancer patients in developing countries and can be used effectively with acceptable morbidity.
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Wang CH, Wong YK, Wang CP, Wang CC, Jiang RS, Lai CS, Liu SA. Risk factors of recipient site infection in head and neck cancer patients undergoing pectoralis major myocutaneous flap reconstruction. Eur Arch Otorhinolaryngol 2014; 272:3475-82. [DOI: 10.1007/s00405-014-3372-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 10/22/2014] [Indexed: 11/24/2022]
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Avery C. A perspective on the role of the pectoralis major flap in oral and maxillofacial oncology surgery. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/ors.12080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- C. Avery
- University Hospitals of Leicester; Leicester UK
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Rocha-e-Silva M, Maris Gomes A. A survey of recently published papers on orthopedics in the Brazilian scientific press. ACTA ORTOPEDICA BRASILEIRA 2012; 20:367-71. [PMID: 24453633 PMCID: PMC3861957 DOI: 10.1590/s1413-78522012000600010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 06/25/2012] [Indexed: 11/22/2022]
Abstract
This paper is a review of articles published in Brazilian scientific periodicals in recent years. Its main purpose is to bring to the attention of the readership of Acta Ortopedica Brasileira original contributions to the field published in non-specialized journals. We hope that this will serve as a general scientific update for readers. The review includes works published in six ISI indexed non-orthopedic journals, following a literature search conducted in fourteen such journals.
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Thankappan K, Iyer S, Rajapurkar M, Sharma M, Subash P. Flap hitching technique to the teeth after oral cancer resection. J Surg Tech Case Rep 2012; 4:19-21. [PMID: 23066457 PMCID: PMC3461771 DOI: 10.4103/2006-8808.100347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES After resection of the tumors of oral cavity adjacent to the mandible, it is a common situation that the whole of one side of the gingival mucosal segment has to be stripped off the mandible to get an adequate margin. When a cutaneous flap is used for reconstruction, it has to be hitched to the teeth to get a watertight seal. We describe a technique to hitch the flap to the adjacent teeth in such an instance. MATERIALS AND METHODS The technique was applied in 10 patients with oral cancer, resected, and reconstructed with cutaneous flaps. RESULTS The technique was found to be effective in all 10 patients. Adequate seal was obtained in all patients. Oral diet was started within 7 days. CONCLUSION An effective and simple technique to approximate a cutaneous flap to the teeth-bearing mandible, when all the mucosa is removed as part of oncological resection, is reported.
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Affiliation(s)
- Krishnakumar Thankappan
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Analysis of 120 pectoralis major flaps for head and neck reconstruction. Arch Plast Surg 2012; 39:522-7. [PMID: 23094249 PMCID: PMC3474410 DOI: 10.5999/aps.2012.39.5.522] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 07/18/2012] [Accepted: 08/01/2012] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND A pectoralis major flap is one of the standard tools for the reconstruction of defects of the head and neck. Despite the technical advancement in free tissue transfer in head and neck reconstruction, the benefits of a pectoralis major flap should not be overlooked. The purpose of this study is to evaluate our 17 years of experience in reconstructing defects of the head and neck region using the pectoralis major flap. METHODS We retrospectively reviewed the medical records of 112 patients (120 cases) who underwent pectoralis major flap operations for head and neck reconstruction during a period ranging from 1994 to 2010. RESULTS In our series, no total necrosis of the flap occurred. Of the total cases, 30.8% presented with flap-related complications. Major complications occurred in 20% of all of the cases but were then all successfully treated. The male sex was correlated with the occurrence of overall complications (P=0.020) and major complications (P=0.007). Preoperative albumin levels of <3.8 g/dL were correlated with the formation of fistula (P=0.030). Defects of the hypopharynx were correlated with the occurrence of major complications (P=0.019) and the formation of fistula (P=0.012). Secondary reconstructions were correlated with the occurrence of overall complications (P=0.013) and the formation of fistula (P=0.030). CONCLUSIONS A pectoralis major flap is still considered to be a safe, versatile one-stage reconstruction procedure in the management of the defects of head and neck and the protection of the carotid artery.
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Reconstructive options after total laryngectomy with subtotal or circumferential hypopharyngectomy and cervical esophagectomy. Curr Opin Otolaryngol Head Neck Surg 2012; 20:77-88. [PMID: 22327791 DOI: 10.1097/moo.0b013e328350a5cc] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW The present review is focused on the main reconstructive options currently used after partial or circumferential resection of the hypopharynx and cervical esophagus. The advantages and disadvantages of pectoralis major myocutaneous (PMMC) pedicled flap, fasciocutaneous free flaps as radial forearm and anterolateral thigh (ALT), and visceral free grafts like jejunum and gastro-omental are overviewed. RECENT FINDINGS For partial hypopharyngeal defects with limited extension to the cervical esophagus, no specific pedicled or free flap is deemed superior over others: the patient's body habitus and surgeon's preference remain the most important factors affecting the reconstructive choice. In contrast, after circumferential hypopharyngectomy, pharyngocutaneous fistula (PCF) and stricture rates of PMMC are higher than those obtained by free flaps. In the most recent series applying ALT and jejunum, PCF and stricture occurrence is comparable, whereas reduced mortality, overall complication rate, and donor-site morbidity of ALT and its better swallowing and speech outcomes have contributed to make this option progressively more popular. On the other hand, gastro-omental seems to offer an unparalleled amount of highly vascularized tissue to manage the difficult situation of salvage surgery after chemoradiation, even though complication rates remain not negligible and this technique has not been widely adopted. SUMMARY The reconstructive armamentarium of head and neck surgeons involved in hypopharyngeal and cervical esophagus reconstruction should encompass every option described herein in order to appropriately deal with specific clinical needs and patient requirements. However, fasciocutaneous free flaps (especially ALT) seem to play an ever greater role in restoration of pharyngoesophageal continuity.
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Ribeiro Salles Vanni CM, de Matos LL, Faro Junior MP, Ledo Kanda J, Cernea CR, Garcia Brandão L, Pinto FR. Enhanced morbidity of pectoralis major myocutaneous flap used for salvage after previously failed oncological treatment and unsuccessful reconstructive head and neck surgery. ScientificWorldJournal 2012; 2012:384179. [PMID: 22645420 PMCID: PMC3356710 DOI: 10.1100/2012/384179] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 02/12/2012] [Indexed: 11/17/2022] Open
Abstract
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 (P = 0.013) as well as in patients submitted to surgery in association with radiation therapy as a previous cancer treatment (P = 0.002). The former condition is also associated with major reconstruction failure (P = 0.018). An even lower incidence of major complications was noted in patients under the age of 53 (P = 0.044). 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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Kekatpure VD, Trivedi NP, Manjula BV, Mathan Mohan A, Shetkar G, Kuriakose MA. Pectoralis major flap for head and neck reconstruction in era of free flaps. Int J Oral Maxillofac Surg 2012; 41:453-7. [PMID: 22260790 DOI: 10.1016/j.ijom.2011.12.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 10/16/2011] [Accepted: 12/19/2011] [Indexed: 11/29/2022]
Abstract
The aim of this study was to evaluate factors affecting the selection of pectoralis major flap in the era of free tissue reconstruction for post ablative head and neck defects and flap associated complications. The records of patients who underwent various reconstructive procedures between July 2009 and December 2010 were retrospectively analysed. 147 reconstructive procedures including 79 free flaps and 58 pectoralis major flaps were performed. Pectoralis major flap was selected for reconstruction in 21 patients (36%) due to resource constrains, in 12 (20%) patients for associated medical comorbidities, in 11 (19%) undergoing extended/salvage neck dissections, and in 5 patients with vessel depleted neck and free flap failure salvage surgery. None of the flaps was lost, 41% of patients had flap related complications. Most complications were self-limiting and were managed conservatively. Data from this study suggest that pectoralis major flap is a reliable option for head and neck reconstruction and has a major role even in this era of free flaps. The selection of pectoralis major flap over free flap was influenced by patient factors in most cases. Resource constraints remain a major deciding factor in a developing country setting.
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Affiliation(s)
- V D Kekatpure
- Department of Head and Neck Oncology, Mazumdar-Shaw Cancer Center, Narayana Hrudayalaya, Health City, Bangalore,
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Saito A, Minakawa H, Saito N, Nagahashi T. Indications and Outcomes for Pedicled Pectoralis Major Myocutaneous Flaps at a Primary Microvascular Head and Neck Reconstructive Center. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/mps.2012.24025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Pinto FR, Kanda JL. Delayed pharyngoesophageal reconstruction with combined local and regional flaps: a case report. EAR, NOSE & THROAT JOURNAL 2011; 90:E20-4. [PMID: 21412728 DOI: 10.1177/014556131109000319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We describe an unusual technique for performing delayed pharyngoesophageal reconstruction following circumferential pharyngolaryngectomy. The patient was a 52-year-old man who underwent a circumferential pharyngolaryngectomy for the treatment of hypopharyngeal carcinoma. In view of the patient's poor clinical status, we opted to perform a pharyngostomy and an esophagostomy and to postpone pharyngoesophageal reconstruction for a more appropriate occasion. After the patient's clinical condition had sufficiently improved, the repair was planned. Microsurgical flaps were contraindicated because the blood flow through the cervical vessels was unreliable. Pharyngoesophageal continuity was restored with a cervical flap vascularized by the prevertebral fascia, a pectoralis major myocutaneous flap, and a deltopectoralis flap. A reasonable degree of deglutition was achieved, and no signs of stricture were detected. Although our technique was unusual, we believed that it might provide a valid alternative when a delayed pharyngoesophageal reconstruction is required and free flaps are contraindicated for any reason.
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Affiliation(s)
- Fábio Roberto Pinto
- Department of Head and Neck Surgery, Hospital de Ensino da Faculdade de Medicina do ABC, Rua Carlos Tiago Pereira No. 915, Apt. 121, São Paulo 04150-080, Brazil.
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