Comparison between functional pectoralis major myocutaneous flap and conventional flap in oral cancer patients

Abstract

Pectoralis major myocutaneous (PMMC) flap has been the workhorse of reconstruction in oral cancer patients. However, it does have a deleterious effect on the patient’s speech, food ingestion and overall cosmetic appearance. ‘Functional PMMC flap’ reconstruction had been introduced in the 1990s for ameliorating these problems but has not gained documented popularity over the last 3 decades. The purpose of the study was to evaluate the aesthetic and functional advantage of a modified functional PMMC flap over conventional PMMC flap. As both harvesting techniques of PMMC flaps were being done for a long period at our hospital, an observational study of 50 patients was conducted, patients were followed over a period of 1 year at 3 month intervals. The criteria of assessment for the categories of speech, food ingestion and appearance were kept simple and easily reproducible. Overall scores were compared. Complications in the immediate post-operative period in both groups were also assessed. Aesthetic and functional assessment scores were observed to be statistically significant in the functional PMMC group as compared with those in conventional PMMC flap throughout the 1-year period. No complications were recorded in the functional PMMC group in the immediate post-operative period. Our observations confirm that functional PMMC flap provides more acceptable aesthetic and functional outcome over conventional PMMC flaps with no complications. We advocate its primary use in certain settings especially where access to microsurgical techniques is absent. Level of evidence: Level III, therapeutic study.