Management of necrotic neck wounds with a "sandwich" pectoralis myocutaneous flap

Primary laryngopharyngeal reconstruction using pectoralis major myocutaneous flaps - Our experience

Twenty-one eases of laryngectomy/laryngopharyngectomy that required primary reconstruction with P. M. M. C flaps at the Division of Surgical Oncology, Regional Cancer Centre, Triyandrum were studied retrospectively from July 1995 to December 2090 and compared with the in cases where primary closure of the neopharynx was done.Four of the 21 cases developed post operative pharyngocutaneous fistulae PCF(I9%) which healed Complefely within an average period of I week compared to 4 PCFs (40%) after primary closure. (n=10), where the average healing time was 12.5 days, with I recurrence. The average duration of Onset of fistula was relatively earlier in cases that required primary closure (II days) compared to those cases where P. M. M. C flap was used for reconstruction (12.5 days). All complications were Wound related and managed conservatively.

Management of carotid artery exposure with pectoralis major myofascial flap transfer and split-thickness skin coverage

The risk for post-operative exposure of the carotid artery due to skin flap necrosis after major head and neck surgery is increased after previous radiation and in severely malnourished patients. Eight patients are described who presented with an (imminent) carotid exposure one to eight weeks after surgery. Pectoralis major myofascial flap transfer with split thickness skin graft coverage was used for protection of the carotid artery. All cases were managed successfully and healed primarily in two to four weeks with acceptable cosmesis. We advocate immediate treatment in the event of an exposed carotid (or imminent exposure) by a pectoralis major myofascial flap with split-thickness skin grafting.

Double skin island pectoralis major myocutaneous flap with nipple-areola complex preservation: a case report

A horizontal double skin island pectoralis major myocutaneous flap with preservation of nipple-areola complex is described, a different modification used to reconstruct a complex defect following radical resection of a locally advanced gingival carcinoma. The skin islands are horizontally separated by a distance of 2.5 cm but rely on one vascular pedicle for their blood supply. The muscle between the skin islands provides the soft tissue bulk between the internal mucosal and external skin lining. The need for a separate segmental flap or a split-thickness skin graft for mucosal lining was eliminated.