P0184 Pectoralis major myocutaneous flap reconstruction after major head and neck resections in salvage surgeries

Abstract

Background Patients with recurrences after primary chemoradiation are the most difficult group to be treated by head and neck oncologists. After the use of chemotherapy and radiation, surgery can rescue outcomes. But during salvage surgeries, major resections have to be contemplated that require large-volume reconstructive procedures. Pectoralis major myocutaneous flap (PMMCF) reconstruction is an ideal flap for this scenario. We aimed to assess the usefulness of PMMCF in reconstruction after major head and neck resections during salvage surgery. Methods For 48 months, we studied 136 patients with recurrences of head and neck cancers after primary chemoradiation. Patients underwent major head and neck resections followed by immediate reconstruction with PMMCF. Outcomes were quality of life, oncological safety, and cosmetic outcomes after reconstruction with PMMCF. We assessed oncological safety with margin status; cosmetic outcome with photographs taken at 1 month, 3 months, 6 months and 1 year; and personal experience and quality of life with a questionnaire. Findings The age range of patients was 31–72 years. Operating time ranged from 130 min to 210 min (mean 153.9). Blood loss ranged from 75 mL to 300 mL (mean 134 mL). The skin island used for volume replacement ranged from 4 cm by 3 cm to 10 cm by 6 cm. No patient had margin positivity or close margins. Three patients had major wound complications and five had minor wound complications. Five patients developed a fistula and five had flap loss. The follow-up period ranged from 12 months to 23 months. For quality of life score, 86% of patients gave a satisfactory score. Interpretation PMMC is an ideal flap with good cosmetic outcomes, oncological safety, and quality of life outcomes. Its usefulness can be extended to major head and neck resections in salvage surgeries.