Role and Reliability of Pectoralis Major Myocutaneous Flap in Oro Facial Reconstruction

Abstract

Background Pectoralis major myocutaneous (PMMC) flap has been used in head and neck reconstruction since its initial description. Its reliability and versatility made it the workhorse flap until the widespread rise of the microvascular surgery. The vascular supply to the pectoralis major is based on branches of the axillary artery. The skin overlying the pectoralis major receives most of its blood supply from fasciocutaneous perforators. In the literature, the flap is also associated with a high incidence of complications in addition to its large bulk. This case report shows the reliability and indication of this flap in the reconstruction of the oral defects. Case Report A 42-year-old male patient reported with the chief complaint of increasing pain and nonhealing ulcer in his left lower posterior teeth region with reducing ability to open mouth. On clinical examination, an ulceroproliferative lesion was found on the left retromolar trigone region (RMT). Biopsy was performed which demonstrated squamous cell carcinoma of left RMT. Modified radical neck dissection type II was performed with hemimandibulectomy without disarticulation with reconstruction with the PMMC flap. Conclusion It can be concluded that the flap-related complications can be minimized by proper planning with regard to the length of the PMMC flap, the defect location, and the type of mandibular osteotomy. There are some situations in which pectoralis major still appears as a valuable option even in facilities performing free flaps and for patients in good general conditions.