Major Myocutaneous Flap Reconstruction Research Articles

Salvage Reconstruction of Extensive Recurrent Oral Cancer Defects With the Pectoralis Major Myocutaneous Flap

This study aimed to evaluate the usefulness of the pectoralis major myocutaneous flap for reconstruction of oral and facial defects after excision of recurrent oral cancer and the results of salvage surgery. Twenty-four patients with recurrent squamous cell carcinoma of the oral cavity underwent salvage surgical treatment. Pectoralis major flaps were used for reconstruction of the extensive defects caused by excision of the tumors. The complications of the flap and the prognosis of the patients were analyzed with a follow-up from 5 to 65 months (mean = 18.5 months). Fourteen flaps were used for mucosal lining of the mouth, and 10 flaps were used for reconstruction of the cutaneous defects. The overall success rate of the flap was 70.8%. Flap-related complications developed in 13 patients (54.2%). Major complications occurred in 7 patients (29.2%), and minor complications occurred in 6 (25.0%). Three patients (12.5%) had complications unrelated to the flap. The reconstruction of the base of the tongue, the floor of the mouth, and the oropharynx emerged as a significant risk factor for flap necrosis on binary logistic regression analysis (P < .05). The overall 1-, 3-, and 5-year overall survival rate was 72.8%, 30.9%, and 20.6%, respectively. The pectoralis major myocutaneous flap is a reliable choice for reconstruction of extensive soft tissue defects caused by excision of recurrent oral cancer. The major complications correlate with the site of reconstruction. Many patients benefit from salvage surgery, and some of them can survive 2 to 4 years postoperatively.

Fracture of the clavicle following the island type of pectoralis major myocutaneous flap for reconstruction of head and neck defect

Fractures of the clavicle following radical neck dissection (RND) and/or radiation therapy have been previously noted in the literature. Interestingly, we experienced three cases of clavicular fracture, which were considered to have resulted from pectoralis major myocutaneous flap (PMMCF). All of these three cases had received the combined treatment of RND, PMMCF and postoperative radiotherapy on the side of fracture. In all three cases, ipsilateral lower neck received 4,500 cGy and island type of PMMCF was used for reconstruction of surgical defect in head and neck area. All fractures noted between 1 and 3 years postoperatively occurred on the medial portion of the clavicle. Devascularization after stripping of periosteum and altered mechanics of the clavicle following resection of clavicular head of pectoralis major muscle may contribute to develop this rare complication in addition to the effect of radiotherapy and RND. We present three cases of the clavicle fracture following the island type PMMCF with a review of literature.

The Pectoralis Major Myocutaneous Flap for Reconstruction of Soft-Tissue Oncologic Defects

The Pectoralis Major Myocutaneous Flap for Reconstruction of Soft-Tissue Oncologic Defects

Pectoralis major myocutaneous flap for reconstruction of partial circumference hypopharyngeal defects

Reconstruction of partial defects of the Hypopharynx and Cervical esophagus following resection for locally advanced carcinoma, by pectoralis major myocutanous flap (PMMF) was studied in 30 consecutive cases over a period of 5 years from 1988–1992 at the Tata Memorial Hospital. Patients with circumferential excisions were excluded for the purpose of this study. Two patients died in the post-operative period due to massive upper GI haemorrhage and cerebrovascular accident. These 2 patients were excluded from further analysis. Satisfactory oral intake was achieved in 26 (85%) patients. Pharyngocutanous fistula (PCF) developed in 10 (29%) patients. Anastomotic strictures developed in 4 patients, out of 2 were benign and 2 were due to recurrence of disease. Median hospital stay in patients who developed PCF was 39 days as against 14 days in those who did not develop PCF. With a minimum follow up of two years 47% patients are dead of disease, 32% are lost to follow and only 14% are alive and free of disease. Statistical analysis using univariate and multivariate tests failed to reveal any significant predisposing risk factors for PCF. Patch PMMF for the reconstruction of partial defects of the hypopharynx is a safe and reliable procedure.

Liposuction for Debulking the Pectoralis Major Myocutaneous Flap

J. Regan Thomas, MD, and Robert Cueva, MD, of Washington University, St Louis, and Terence Davidson, MD, San Diego, recently reported their results using liposuction to debulk pectoralis major myocutaneous flaps. Their presentation was at the spring meeting of the American Academy of Facial Plastic and Reconstructive Surgery in Denver. Thomas, who presented the article, stated that one difficulty in using the pectoralis major myocutaneous flap for reconstruction of head and neck defects is the excessive bulk of this particular flap. Because most of this extra soft tissue is subcutaneous fat, the authors devised an experiment to remove the fat by liposuction. Since a major concern was destroying the cutaneous blood supply to the skin paddle, they used five cadavers, in which the brachial arteries were dissected and India ink was infused. Using each cadaver for its own control, staining the skin over the pectoralis major muscle was observed on

Use of the pectoralis major myocutaneous flap for reconstruction of large cervical, facial or cranial defects

The pectoralis major myocutaneous flap has been very reliable for reconstruction of large facial defects, orbital exenteration and radical temporal bone resection. Experience with this flap in such extensive resections in 12 consecutive patients in whom the flap was transferred successfully in one stage is reported.