Major Myocutaneous Flap Reconstruction Research Articles

Pectoralis Major Myocutaneous Flap in Reconstruction after Salvage Laryngectomy

Pectoralis Major Myocutaneous Flap in Reconstruction after Salvage Laryngectomy

Reconstruction plate In the Substance of Pectoralis Major Myocutaneous Flap for Reconstruction of the Mandibular Arch Defects: a Novel Technique (RISP Technique)

Reconstruction plate In the Substance of Pectoralis Major Myocutaneous Flap for Reconstruction of the Mandibular Arch Defects: a Novel Technique (RISP Technique)

Quality of Life Assessment and Comparative Analysis of Anterolateral Thigh Flap and Pectoralis Major Myo-cutaneous Flap for Reconstruction of Post Excision Defects of Oral Squamous Cell Carcinoma.

Present study is a comparative evaluation of the financial impact on choice of flap, clinical results as well as post resection quality of life assessment of cancer patients reconstructed with anterolateral thigh(ALT) flap and pectoralis major myo-cutaneous(PMMC) flap. Ethical clearance was obtained from institutional ethical committee. In this non-randomised, prospective study design among 49 oral squamous cell carcinoma cases, 39 cases were reconstructed using PMMC flap and 10 using ALT flap from year 2020 to 2022. These 2 flaps were compared in terms of parameters like time utilised for reconstruction, hospital stay, overall survival and Washington University Quality of Life index(UW-QOL) for head and neck cancer. Patients were followed regularly for post-operative complications. The University of Washington Quality of Life score (UW-QOL) questionnaire, version 4, was completed at six months post-operatively. Obtained data was statistically analysed using IBM® SPSSⓇ. Washington University Quality of Life index scores and esthetics are better with Antero-lateral thigh flap, with less overall post-operative complications. On the other hand Pectoralis myocutaneous flap has less surgical time and more salvage potential. Despite of Antero-lateral thigh flap having Good Washington University Quality of Life index scores, lesser post-operative complications and better esthetics; scale of developing nations is still tipping towards economical, less time consuming and less technique sensitive Pectoralis major myocutaneous flap.

Folded Pectoralis Major Myocutaneous Flap for Reconstruction of Complex Oral Commissural Defects: A Retrospective Case Series and Technical Report.

Full thickness defects following surgical resection of locally advanced carcinoma buccal mucosa involving oral commissure often require complex microvascular procedures that are technically demanding. We present a novel technique of folded pectoralis major myocutaneous flap for reconstruction of such defects without the need for free flaps or additional sling support.

Comparison Between Radial Forearm Free Flap and Pectora is Major Myocutaneous Flap for Reconstruction in Oral Cavity Cancer Patients: Assessment of the Quality of Life

We aimed to evaluate the quality of life of Chinese patients after immediate reconstruction surgery on individuals with oral cavity cancer. In addition, we compared the differences between radial forearm free flap and pectoralis major myocuta- neous flap. Using the University of Washington quality of life v4 questionnaire, 1:1 matched research was performed on patients received PMM or RFF flap. Chi-square test was used to analyze the variables. One hundred twenty four of 179 questionnaires were returned (69.3%). Age, N stage, and postoperative radiotherapy were similar for both groups. However, there were significant differences between two groups in gender, T stage, operation duration, and complication rate. Oral cavity cancer patients reconstructed with radial forearm free flap had better shoulder and speech functions but worse appearance domains. The results of our research provide important information for patients and physicians during their discussion of treatment programs for oral cavity cancers.

Unipedal pectoralis major myocutaneous flap for reconstruction of skin defects in oral cancer surgery: A prospective study of 40 cases

Background: Reconstruction following oral cancer is very important part of the treatment defining both aesthetic and functional aspects. Options available for reconstructions are regional pedicle flaps and microvascular free flaps. Pectoralis major myocutaneous (PMMC) flap is regarded as the workhorse for reconstruction in the area of oral cavity and neck. A unipedicle PMMC is a good option for reconstruction of full thickness defects after resection of tumors of oral cavity. Material and Methods: A study was undertaken on patients of soft tissue defects of head and neck region after resection of tumor of oral cavity (squamous cell carcinoma). Total 40 patients, who were treated in the department of surgical oncology were included in this study. Results: Gingivo-buccal complex was the most common site observed for oral malignancy and majority of patients were in TNM stage- III in this study. Flap survival was good in majority of cases excluding one case of total flap necrosis and 5 cases of minor edge necrosis. Conclusions: Unipedal PMMC flap is effective in reconstruction of full thickness defect of oral cavity defects even in the era of free flap reconstructions especially in developing countries. Despite few minor flap related complications PMMC flap survival rate is high and total flap necrosis rate is uncommon.

Clinical Analysis of Pectoralis Major Myocutaneous Flap for Reconstruction of Tissue Defects after Pharyngolaryngeal Cancer Surgery

Objective: To explore the methods and effects of pectoralis major myocutaneous flap in pharyngolaryngeal cancer surgery. Methods: Among 23 cases of pharyngolaryngeal cancer patients, the surgical procedure was based on pathologic conditions, and the surgical defects were repaired by pectoralis major myocutaneous flap. Results: Among 23 patients, there were 1 case of skin flap necrosis, 4 cases of pharyngeal fistula, 1 case of hypopharyngeal esophageal stenosis; except 1 case of pharyngeal fistula died of carotid artery rupture caused by infection, 1 case of hypopharyngeal esophageal stenosis required a gastric tube, and the rest patient’s swallowing function is normal. Conclusion: The blood supply of pectoralis major myocutaneous flap is reliable with the tissue volume enough for reconstruction. It turns out to improve patient survival and postoperative quality of life with the application of pharyngolaryngeal cancer surgery.

Utility of island bipaddle pectoralis major myocutaneous flap in reconstruction of full thickness lower gingivo-buccal sulcus defects

<p class="abstract"><strong>Background:</strong> Aims of the study was to evaluate the usefulness of island bipaddle pectoralis major myocutaneous flap in the reconstruction of through and through lateral gingivobuccal sulcus defects.</p><p class="abstract"><strong>Methods:</strong> This was a retrospective study carried out from 2013 - 2019 in the department of otorhinolaryngology and head and surgery at Sri Devaraj Urs Medical College and Hospital. After obtaining institutional ethical committee clearance. Sixty-one patients diagnosed with stage IV a lateral Gingivobuccal squamous cell carcinoma with skin involvement and reconstructed using island bipaddle pectoralis major myocutaneous flap were included in the study. </p><p class="abstract"><strong>Results:</strong> Majority of our patients were females. Nearly 50% of our patients had skin involvement secondary to Level-I nodal metastasis. Nine patients in our study developed complications. Among them seven patients had minor complications and in two patients the flap failed.</p><p class="abstract"><strong>Conclusions:</strong> In resource constraint places where microvascular reconstruction facilities are not available and where replacing bone is not mandatory, island bipaddle pectoralis major myocutaneous flap can be used effectively as single stage reconstruction option for full thickness lower gingivo-buccal sulcus defects.</p>

A Modified Design of the Pectoralis Major Myocutaneous Flap for Reconstruction of Head and Neck Defect.

Even though the pectoralis major myocutaneous flap (PMMF) still has an important role in the free flaps ear, it is reported to have drawbacks such as the limited cephalad extension and high incidence of total or partial flap necrosis. Various modifications have been attempted to augment the limited cephalad extension and a stable blood supply.The aim of this study is to describe a modified design of the skin paddle and preparation of the PMMF, to achieve stable blood circulation and sufficient pedicle length. The priority skin paddle is the medial part for its stable blood supply, and the lateral margin should be adjusted as needed. During the harvesting, the lateral thoracic artery (LTA) is preserved to protect the perforating branches, and the anterior sheath of the rectus abdominis muscle is used as a suture margin to prevent damage of the thin muscle of the PMMF. The skin paddles in this study are larger than those previously reported. All of the 21 patients in our study, the skin paddles show complete survival with no partial necrosis of skin paddle, fistula, or wound dehiscence.It is worthwhile to consider and preserve the LTA as a major contributor to a lateral and distal PMMF. This study would be useful in future and preparation of the PMMF in head and neck reconstruction.

Versatility of Pectoralis Major Myocutaneous Flap for Reconstruction of Large Oral Cavity Defects

Abstract Background: Oral cavity reconstruction is one of the most challenging and progressive areas in reconstructive surgery. In oral cavity reconstruction the main goals are prompt and safe restoration of mucosal integrity, avoid oro-cutanoeus fistula with restoration of the bony support whenever needed, followed by restoration of the function then lastly restoration of the form (aesthetics). Aim of Study: The aim of our study is to evaluate the feasibility of using pectoralis major muscle myocutaneous flap in reconstruction of oral cancer post excision defects. Patients and Methods: This is a retrospective study in which sixteen patients with oral cavity malignant tumors underwent surgical excision and immediate reconstruction, during the period from July 2016 to July 2019 with pectoralis major myocutaneus flap as regard peri operative evaluation and post operative complications. Results: This retrospective study included 16 patients with oral malignancy with reconstruction of the oral defect using pectoralis major myocutaneous flap. The mean duration of follow-up in all patients was 13.8 months (ranged from 6 to 30 months). From 16 patients, 4 patients (25%) patients had De-novo cancers, while the rest were recurrent cases. Conclusion: Pectoralis major myocutaneous flap is considered as an easy, simple method in cases of large oral cavity defects. It can be used as a back up or an alternative to free tissue transfer or even as salvage procedure.

Crossed pectoralis major myocutaneous flap for recurrent oral cavity cancers.

Background:Oral cavity cancers are fairly common and have propensity to recur locally. Since Pectoralis Major Myocutaneous (PMMC) flap is the most widely used first flap for reconstruction, it is exhausted at the earliest and recurrence poses a formidable challenge for reconstructive surgeon. Present study evaluated the feasibility of contralateral Pectoralis Major Myocutaneous Flap for reconstruction after resection of recurrent tumour.Methods:This was a study of the patients presenting with recurrent oral cavity cancer after exhausted ipsilateral Pectoralis Major Myocutaneous Flap (PMMC) in whom we used contralateral Pectoralis Major Myocutaneous Flap (Crossed PMMC Flap) for reconstruction between October 2013 to June 2016.Results:Five patients with recurrence underwent reconstruction with contralateral Pectoralis Major Myocutaneous Flap. In all the flap was successfully used to reconstruct defects involving the entire buccal mucosa and in one patient the flap could be used to reconstruct full thickness resection defect(crossed bipedal PMMC Flap) with ease.Conclusion:Crossed Pectoralis Major Myocutaneous Flap can be used safely and reliably for reconstruction of the buccal mucosal defect and in selected patients even for full thickness cheek defect as folded bipaddle Pectoralis Major Myocutaneous Flap.

The application of pectoralis major myocutaneous flap in reconstruction of surgical defect for oropharyngeal cancer

Objective To explore the clinical value of using pectoralis major myocutaneous flap in surgery with various adverse factors for advanced oropharyngeal cancer. Methods 15 patients who presented with advanced oropharyngeal cancer were performed for radical surgery, and pectoralis major myocutaneous flaps were applied for immediate reconstruction of surgical defect.In all cases, various adverse factors(advanced age, diabetes, cardiovascular disease, radiation damage, etc.) were existed.The effect of reconstruction was observed. Results All surgeries were successful, and all patients tided over perioperative period.The average time of operation was 5 hours with a range of 4 to 6 hours.The average time cost for flap preparation was 40 minutes with a range of 40 to 55 minutes.The completely survival rate of flaps was 93%.Partial skin necrosis occurred in 1 case(7%); and submandibular fistula occurred in another one(7%). Two patients(13%) developed wound infection.All of them were healed by symptomatic treatment. Conclusion For the patients with advanced oropharyngeal cancer and various adverse factors of surgery, pectoralis major myocutaneous flap can be used as salvage measure in reconstruction of surgical defect, which is more secure than free flap. Key words: Musculocutaneous flap; Pectoralis muscles; Oropharyngeal neoplasms; Repair surgery

Substitution of failed radial forearm flap by reverse pectoralis major myocutaneous flap for reconstruction intra and extra oral defects

Substitution of failed radial forearm flap by reverse pectoralis major myocutaneous flap for reconstruction intra and extra oral defects

Extended vertical lower trapezius island myocutaneous flap versus pectoralis major myocutaneous flap for reconstruction in recurrent oral and oropharyngeal cancer.

The purpose of this study was to compare the use of an extended vertical lower trapezius island myocutaneous flap (TIMF) and a pectoralis major myocutaneous flap (PMMF). A total of 39 patients with advanced recurrent oral and oropharyngeal squamous cell carcinoma (SCC) underwent salvage surgery followed by placement of either an extended lower vertical TIMF or PMMF for reconstruction. Twenty-one patients received extended lower vertical TIMFs, whereas 18 received PMMFs. The pedicle length of the TIMF was longer than that of the PMMF, and the skin paddle of the TIMF was both wider and longer than the PMMF. No major complication developed in any of the patients. The TIMF group experienced a lower rate of minor flap failure than did the PMMF group. Use of an extended vertical lower TIMF, which has a longer pedicle flap and a larger skin paddle than a PMMF, is optimal for reconstruction of major defects. © 2015 Wiley Periodicals, Inc. Head Neck 38: E159-E164, 2016.

Does pectoralis major flap harvesting induce upper extremity dysfunction?

To evaluate the effect of pectoralis major myocutaneous (PMM) flap reconstruction on upper extremity dysfunction. Patients undergoing PMM flap reconstruction following head and neck cancer resection were enrolled. The control group comprised age-, sex- and clinical characteristic-matched patients undergoing non-PMM flap reconstruction. All patients completed the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire preoperatively and >1 year postoperatively. There was no significant difference between pre- and postoperative DASH scores in the control group (n = 46; 2.38 ± 3.33 and 2.99 ± 4.21, respectively). In the PMM flap group (n = 46), the postoperative DASH score was significantly higher than the preoperative score (7.00 ± 9.13 and 2.44 ± 3.50, respectively). In the PMM flap group, flap size was significantly associated with postoperative DASH score. PMM flap reconstruction has a small but significant negative effect on upper extremity dysfunction.

Modified pectoralis major myocutaneous flap in reconstruction of head and neck defects

To report the experience of use of modified pectoralis major myocutaneous (PMMC) flaps in reconstruction of head and neck postoperative defects. A total of 107 patients who underwent head and neck defect reconstruction using modified PMMC flaps after tumor rescetion between Jan 2008 and Dec 2013 were analyzed retrospectively. The success rate of reconstruction with modified PMMC flaps was 94.4% (101/107). Five patients had partial flap necrosis and their wounds healed with dressing change. One patient (0.9%) had total flap necrosis, followed by the second reconstruction using contralateral PMMC flap. The modified falcate PMMC flap can obtain optimum quantity of the skin in the chest and decreasing the closing tension of the donnor site in favor of wound healing. The pedicle without muscle will not only maintain the partial function of the pectoralis major, but also help to avoid pressing the vascular pedicle within the subclavian tunnel. The muscular element the pedicled muscles of the PMMC flap can increase the ability of the flap to resist infection, which can use for covering an exposed carotid artery and improving the neck fibrosis of irradiated patients.

Resection and reconstruction of giant cervical metastatic cancer using a pectoralis major muscular flap transfer: A prospective study of 16 patients.

If not promptly or properly treated, certain cervical metastatic cancers that develop from unknown primary tumors may rapidly grow into giant tumors that can invade the blood vessels, muscle and skin. The present study examined the feasibility and efficacy of radical neck dissection combined with reconstruction using the pectoralis major myocutaneous flap for the treatment of giant cervical metastatic cancers that have developed from unknown primary tumors and have invaded the skin. A total of 16 patients who met the inclusion criteria were subjected to radical neck dissection to adequately resect invaded skin, and the pectoralis major myocutaneous flap was used to repair the large skin defect created in the cervical region. Following the surgery, the patients received concurrent chemoradiotherapy. The pectoralis major myocutaneous flap survived in all 16 patients, with no cases of flap necrosis. In addition, no post-operative lymphedema, paresthesia or dysfunction of an upper extremity occurred due to the cutting of a pectoralis major muscle. In 9 cases, patients were satisfied with their post-operative shoulder movement at the donor site; in the remaining 7 cases, patients felt greater weakness in this region following surgery relative to prior to surgery. The 14 male patients were generally satisfied with the post-operative appearance of the donor region, whereas the 2 female patients were dissatisfied with the appearance of this region. Follow-up for 6-53 months after the patients were discharged following surgery and chemotherapy revealed that the recurrence of cervical tumors in 6 cases. Overall, radical neck dissection combined with the use of the pectoralis major myocutaneous flap for reconstruction is a feasible approach for the treatment of giant cervical metastatic cancers that have developed from unknown primary tumors and have invaded the skin. Post-operative concurrent chemoradiotherapy should be administered to improve the local control rate and patient quality of life, allowing a satisfactory therapeutic efficacy to be achieved.

Thoracoacromial Vessel Based Pectoralis Major Myocutaneous Flap in Oral and Maxillofacial Soft Tissue Defect Reconstruction

Pedicled flaps play an important role in cancer treatment centers, particularly in developing and emerging countries. Although different flaps can be used for facial reconstruction but Pectoralis major myocutaneous flap is still considered the workhorse for maxillofacial reconstruction because of simple procedure and high success rate, while other flaps of facial region ranging from pedicled to free flaps require greater surgical skills along with unpredictable results.The aim of this study is to find outcomes of Pectoralis major myocutaneous flap in reconstruction of middle and lower facial regions. Main outcome measures are vitality of the Pectoralis major myocutaneous flap, donor site morbidity and recipient and donor site complications.This study was carried out on 36 patients in BSMMU and Health & Hope Hospital in Dhaka from 1st April 2005 to 30th June 2011 who require soft tissue reconstruction of defects of middle and lower facial regions. The age and sex of the patients and size of defect were analyzed. Vitality of Pectoralis major myocutaneous flap, donor site morbidity and donor and recipient site complications were studied. In this study, male female ratio was 13:5; mean age 50 the success rate of was 100%. All of the flaps were vital but 13.8% of the flaps had partial loss of flap.Pectoralis major myocutaneous flap is a versatile flap as it can not only provide skin and mucosal cover simultaneously, but also provide adequate muscle bulk for through and through defects. It doesn't cause any hindrance in mandibular movements. DOI: http://dx.doi.org/10.3329/akmmcj.v3i2.11690 AKMMC J 2012: 3(2): 23-29

Combined Free Vascularized Iliac Osteocutaneous Flap and Pedicled Pectoralis Major Myocutaneous Flap for Reconstruction of Anterior Chest Wall Full-Thickness Defect

Large defects of the anterior chest wall lead to gross chest instability that can result in paradoxic respiration. Osteoradionecrosis of the lower sternum and multiple left ribs resulted in a huge, full-thickness defect of the left anterior chest wall in a 67-year-old woman. An iliac osteocutaneous flap (bone segment 3 × 14 cm) was harvested for reconstruction of the bone defect. The skin defect was covered by the skin paddle of the iliac osteocutaneous flap and a contralateral rotational pectoralis major muscle flap. Months postoperatively, the patient was physically active, the chest was stable, and the vascularized iliac bone was incorporated into the recipient bone.

Improved technique of harvesting the pectoralis major myocutaneous flap for reconstruction in female head & neck cancer patients

Improved technique of harvesting the pectoralis major myocutaneous flap for reconstruction in female head & neck cancer patients