Pectoralis Major Myocutaneous Flap Reconstruction Research Articles

Evaluating Pedicled Pectoralis Major Myocutaneous Flap Reconstructions for Oral Malignancy and the Influence of Laterally Based Rotational Advancement Flap on Donor Site Integrity and Nipple Position in Male Patients.

Oral cancer poses a significant health burden, particularly in the male population of India. This study focuses on evaluating the outcomes of 48 pedicled Pectoralis major myocutaneous (PMMC) flap reconstructions in male patients with oral malignancy. Given the challenges associated with microvascular flap reconstructions, especially in advanced cancer cases, older patients, and resource-constrained settings, the PMMC flap still serves as a valuable alternative. The study introduces a novel approach by incorporating a laterally based rotational advancement flap (LBRA) to address donor site integrity and decrease the nipple-areolar complex (NAC) displacement. Traditionally, PMMC flap designs tend to cause inward shifting of the NAC during chest donor site closure, impacting the aesthetic outcome. Surgical techniques involved wide local resection, neck dissection, and PMMC flap reconstruction. The Flap design included a horizontal orientation with adjustments based on defect location. Additionally, a laterally based rotational flap from the chest aided in donor site closure. Results demonstrate the versatility and reliability of PMMC flap reconstructions, with no total flap necrosis or major complications observed in the 48 cases. The LBRA technique effectively mitigated NAC displacement. The study contributes to the existing literature by providing insights into the advantages of PMMC flap reconstructions and introducing a technique to optimize donor site closure and decrease the medial shifting of the nipple. The adaptability, reliable vascular supply, and simplified learning curve make the PMMC flap a preferred choice in resource-constrained settings with high patient demand. In conclusion, this research underscores the continued relevance and effectiveness of the PMMC flap in head and neck reconstruction, offering satisfactory cosmetic and functional results. The introduction of the LBRA technique adds a nuanced dimension to improve outcomes, particularly in male patients with oral malignancy.

Fluoride Application in Patients Undergoing Radiotherapy: An Overlooked Protocol for Preserving Radiant Smiles

Abstract This case report focuses on the rising incidence of oral and maxillofacial tumors, requiring multimodal therapy involving surgery and radiotherapy. Radiotherapy, integral to cancer treatment, poses oral health challenges, notably radiation-related caries. Severe complications such as mucositis, xerostomia, and osteoradionecrosis highlight the critical role of optimal oral hygiene practices in managing these conditions. The presented case involves a 38-year-old male with a history of verrucous carcinoma, undergoing composite resection, modified neck dissection, and pectoralis major myocutaneous flap reconstruction. Adjuvant radiotherapy requires a comprehensive approach to minimize complications. Here, the focus is on fluoride treatment, specifically Fluoritop SR Dental Varnish, to prevent radiation-related caries. A multidisciplinary approach, including fluoride application, vigilant monitoring, patient education, and collaboration, is crucial for minimizing complications in oral malignancy radiotherapy. Emphasizing fluoride’s significance in preventing radiation-related caries, this care plan contributes to awareness and improves oral health outcomes in this patient population.

Pectoralis Major Myocutaneous Flap Reconstruction for Oromandibular Defects: Analysis of Predictors for Optimum Reconstructive Outcome

Pectoralis Major Myocutaneous Flap Reconstruction for Oromandibular Defects: Analysis of Predictors for Optimum Reconstructive Outcome

Reconstruction of partial hypopharyngeal defects following total laryngectomy: Pectoralis major myofascial versus myocutaneous flaps

To date, few comparative studies exist for partial hypopharyngeal defect reconstruction following total laryngectomy. In the absence of objective evidence from comparative studies, the ideal flap choice remains controversial, leading to heterogeneity in institutional treatment protocols. Comparative studies between different reconstructive techniques are required. Therefore, this study compared postoperative outcomes of pectoralis major myocutaneous (PMMC) and myofascial (PMMF) flaps. A single-center retrospective cohort study was performed between 2000 and 2022, which included all consecutive patients who underwent a PMMC or PMMF flap reconstruction following total laryngectomy and partial hypopharyngectomy. Primary outcomes were suture line leakages (conservative management), fistulas (surgical management), and strictures. Secondary outcomes included flap failure, donor-site morbidity, and the start of oral intake. In total, 122 patients were included (109 PMMC and 13 PMMF flap reconstructions). The incidence of suture line leakage was significantly higher (p=0.007) after PMMC flaps (57%) compared with PMMF flaps (15%). Between PMMC and PMMF flaps, fistula (19% vs. 0%) and stricture rates (22% vs. 15%) did not differ significantly. No differences in flap failure, donor-site morbidity, or start of oral intake were observed. PMMF flaps have inherent advantages (e.g., reduced bulk, increased pliability) over conventional PMMC flaps and have non-inferior results compared to the latter in terms of postoperative complications. Although the final choice for reconstruction should be patient-tailored, a PMMF flap can be considered a reliable primary choice that is feasible in most patients.

Assessment of quality of life after soft tissue resection of head and neck carcinoma and reconstruction with double-paddle peroneal artery perforator free flap

We aimed to assess the quality of life for head and neck carcinoma (HNC) patients who underwent soft tissue resection and reconstruction with double-paddle peroneal artery perforator (DPAP) free flap. The quality of life was assessed by means of the University of Washington quality of life (UW-QOL) and the 14-item Oral Health Impact Profile (OHIP-14) questionnaires at 12 months postoperatively. Data from 57 patients were retrospectively analysed. Out of these, 51 patients were at TNM stage III or IV. Finally, 48 patients finished and returned the two questionnaires. In the UW-QOL questionnaire, the mean (SD) higher scores were pain 76.5 (6.4), shoulder 74.3 (9.6), and activity 71.6 (6.1), whereas the lower scores were chewing 49.7 (5.2), taste 51.1 (7.7), and saliva (56.7 (7.4). In the OHIP-14 questionnaire, the higher-scoring domains were psychological discomfort (69.3 (9.6) and psychological disability 65.2 (5.8), whereas the lower-scoring domains were handicap 28.7 (4.3) and physical pain 30.4 (8.1). The DPAP free flap significantly improved appearance, activity, shoulder, mood, psychological discomfort, and handicap compared with pedicled pectoralis major myocutaneous flap reconstruction. In conclusion, DPAP free flap for reconstruction of tissue defects after soft tissue resection of HNC significantly improved the patients' QOL compared to pedicled pectoralis major myocutaneous flap reconstruction.

Optimization of total tongue functional reconstruction with the sushi roll technique and its application in pectoralis major myocutaneous flaps

A protuberant shape and sufficient volume are the most important parameters for total tongue reconstruction. The conventional pectoralis major myocutaneous (PMMC) flap undergoes collapse due to atrophy of the denervated muscle. In a new technique, this flap was rolled up like sushi to reshape the neotongue. This study explored the feasibility and effect of the ‘sushi roll’ technique for precise total functional reconstruction of the tongue using a PMMC flap. Thirty patients scheduled for total glossectomy and PMMC flap reconstruction were recruited. The sushi roll technique was performed in 15 patients and the conventional repair in 15 patients. Outcomes were compared between the two groups. The flap survived in all 30 patients. The sushi roll group showed superior results to the conventional group in terms of time to oral alimentation (P = 0.012) and decannulation (P = 0.041), as well as swallowing function (P = 0.032), speech intelligibility (P < 0.001), shape (P < 0.001), and quality of life score (P < 0.001) at 12 months. The innovative sushi roll technique uses a folding method that utilizes the length rather than the thickness and width of the flap to maintain the volume and protuberance of the neotongue, which results in acceptable function and improved quality of life.

Sinus Bradycardia and Hypotension Following Reconstructive Hemi Mandibulectomy. Unusual Complication of Orofacial Reconstructive Surgery

Postoperative complications following pectoralis major myocutaneous flap in orofacial reconstruction are a well-known entity. Still, literature search didn’t reveal sinus bradycardia as one of those post-operative complications. One of our patients, a 63-year-old gentleman with squamous cell carcinoma in the right cheek, who underwent wide local excision with right side hemi-mandibulectomy and pectoralis major myocutaneous flap reconstruction, developed symptomatic sinus bradycardia and hypotension as a postoperative complication. Initially there was a struggle to find out the underlying cause but later, carotid sinus hypersensitivity was suspected as a probable cause. Ultimately, it was alleviated by a debulking surgery to reduce the pressure in the neck.

High-grade transformation of adenoid cystic carcinoma of parotid gland with isolated intratemporal facial nerve involvement: a case report and literature review

BackgroundHigh-grade transformation Adenoid cystic carcinoma (HGT-AdCC) of the parotid gland is a rare transformation noted in slow growing low grade AdCC. Perineural invasion and spread is an important feature of this tumor. Temporal bone involvement is rare. A total of only 10 cases of HGT-AdCC in parotid gland has been reported in literature so far predominantly in the elderly with peak incidence in 5th–6th decade.Case presentationWe present a young lady of HGT-AdCC of right parotid gland with temporal bone involvement in the form of isolated perineural invasion (PNI) of facial nerve till the tympanic segment. She underwent right radical parotidectomy with modified radical neck dissection with modified lateral temporal bone resection and pectoralis major myocutaneous flap reconstruction. Histopathological examination revealed both low- and high-grade areas. Sections from facial nerve showed tumor invasion.ConclusionThe radiological features of isolated perineural spread in intratympanic part of facial nerve can be easily missed if not specifically looked for. Every attempt should be made preoperatively and intraoperatively to determine the complete extent of the tumor for adequate disease clearance. A combined clinico-radiological approach aided by histopathology examination helps in early detection of this carcinoma and in better patient management.

Analysis of the efficacy of the pectoralis major myocutaneous flap in reconstructive head and neck surgery

IntroductionAlthough free flaps have been used predominantly in past decades for the soft tissue reconstruction of head and neck malignancies, Pectoralis major myocutaneous flap (PMMF) is still a reliable workhorse for patients with co-existing co-morbidities or low economic status where free flaps are not feasible. Patients and methodsIt was a retrospective study done on 36 patients of head and neck malignancies over the period of 5 years in which PMMF was used as a method of reconstruction in our hospital. Patients were followed up for a period of one year and outcome of PMMF was evaluated. ResultsOut of 36 patients 31 were of oral cancer and 5 were of carcinoma hypopharynx. Incidence of total flap necrosis was nil and partial flap necrosis was 16.6%. Orocutaneous fistula was found in 16.6%, wound dehiscence was in 19.4% and infection was found in 13.5% of patients. Non-flap related complications were found in 13.8% of patients. 35 out of 36 patients (97.2%) eventually achieved satisfactory surgical outcome of PMMF reconstruction. ConclusionPMMF is a reliable method of reconstruction for head and neck malignancies especially in basic healthcare settings. With minimal expertise and groundwork, it is still a cost-effective workhorse flap for head and neck reconstruction.

Mango-shaped Bi-paddled pectoralis major myocutaneous flap reconstruction for large full-thickness defects post resection of squamous cell carcinoma of oral cavity: An analysis of 232 cases.

Objectives:The objective of the study was to examine the feasibility of bi-paddled pectoralis major myocutaneous (PMMC) flap reconstruction in patient undergoing full thickness composite resection.Materials and Methods:Inclusion criteria: The subjects chosen were patients with clinically T4A squamous cell carcinoma of buccal mucosa, lower alveolus, and maxilla in with skin involvement. Patients required a full-thickness composite resection of intraoral lesion, bone (mandibular segment and/or maxilla), and overlying involved skin and had modified radical neck dissection. Exclusion criteria: Patients not requiring full thickness composite resection including skin. Patients were observed postoperatively for early and late postoperative complications, starting of oral feeding, post-operative trismus, and dysphagia during subsequent follow-up and cosmetic outcome.Results:Overall, the complication rate was 33.8% out of which only 7.8% required major re-surgery with second flap reconstruction. This is comparable with other large series of PMMC flap. Clavien-Dindo Grade I complications were seen in 9.5%, Grade II in 69.7%, Grade IIIA in 13.4%, and Grade IIIB in 7.45% of patients. Full-thickness partial flap necrosis included necrosis of either the external or the internal skin paddle. There were 15 cases – 6.5% of full thickness external paddle necrosis. These were mostly in patients with bite composite resections and having a larger random fasciocutaneous distal component of the flap without underlying muscle. Furthermore, 40% of these patients were females. In females, the flap necrosis comprised 4 of the 12 patients (33.33%).Conclusion:Pectoralis major mycocutaneous flap has been a boon to reconstruction of the oral cavity post its inception. In case of locally advanced squamous cell carcinomas of the oral cavity, in many instances, there is a clinically significant cervical lymph nodal spread vessels post mandating a comprehensive lymph node dissection. PMMC flap provides a robust well vascularized muscular cover to the cervical vessels poststernocleidomastoid excision.

Giant ameloblastoma

Ameloblastoma is an odontogenic tumor of epithelial origin that can be locally aggressive. These tumors do not normally reach sufficient size to qualify as a giant ameloblastoma mandible as which the patient seeks medical attention before this stage. We report the case of a 33-year-old male who had a giant ameloblastoma of the mandible due to its rarity, size, and management in developing countries. It is probably the largest reported case in the world as per literature. The tumor measured a size of 30 cm × 18 cm × 12 cm involving bilateral ramus, angle, body, and symphysis of the mandible. Computed tomography scan showed a well-defined, multiloculated cystic lesion arising from the entire mandible. Such cases require a total mandibulectomy with osseocutaneous free-flap reconstruction and physiotherapy for rehabilitation. However, in most of the scenarios in rural India, there are limited facilities, and due to poor socioeconomic status, a free flap with phased remodeling is not possible. Hence, in this particular scenario, we performed total mandibulectomy with pectoralis major myocutaneous (PMMC) flap reconstruction followed by physiotherapy and rehabilitation to achieve near-normal life. Therefore, a total mandibulectomy followed by a pedicled PMMC flap reconstruction is a good alternative option in a resource-limited setting.

Retrograde nasal intubation for an anticipated difficult intubation

A 58-year-old female patient with recurrence of carcinoma in the angle of the mouth on the left side was posted for composite resection and Pectoralis major myocutaneous flap reconstruction. The patient had carcinoma left buccal mucosa 1 year back and had undergone left partial mandiblectomy and radiotherapy. On airway examination (MPG) could not be assessed; on mouth opening one-and-half finger was admitted.There was a 4 cm × 4 cm ulceroproliferative growth in the left angle of the mouth extending to lower lip, which was bleeding on touch. After shifting to the operating theatre, venous access was secured with a with a wide-bore cannula. Standard monitoring was connected and preoxygenation was done. Under strict aseptic precaution under local anaesthesia, trachea located with Touhy's needle. Epidural catheter passed through the needle into the larynx and taken out through the oral cavity and Ryle's tube, which the patient already had for feeds, was pulled and taken out of the oral cavity. Catheter tip was tied to it and pulled out through the nostril and passed through murphy's eye of 6.5 mm (ID ETT) and lower end pulled, thereby pulling ETT into the trachea, cuff was inflated and tube fixed at 25 cm. General anaesthesia was administered. Thorough airway assessment, preparat ion and counselling of patient help in reducing airway-related morbidity and mortality.

An alternative method for reconstructing anterior segmental mandibulectomy defects with a plate and pectoral major muscle flap.

Reconstruction of anterior segmental mandibulectomy still remains a challenge. Osteocutaneous free flap remains the ideal choice of reconstruction because it restores cosmesis and function. The use of other locoregional flaps compromises cosmesis and function. Here, we have introduced a unique technique of reconstruction with lingual cortex mandibular plate as an alternate choice for free flap. Six patients aged 12-62 years underwent oncological resection for oral cancer which involved the anterior segment of the mandible. Following resection, they underwent lingual cortex mandibular plating with pectoralis major myocutaneous flap reconstruction. Adjuvant radiotherapy was delivered to all patients. The mean bony defect was 9.2 cm. There were no significant perioperative events related to the surgery. None required tracheostomy and all were safely extubated with no post-surgical complications. The cosmetic and functional outcomes were acceptable. Following the completion of radiotherapy with a median follow-up of 11 months, Plate exposure occurred in one patient. The technique is cheap, quick and simple, and can be effectively applied in resource-constrained and demanding situations. It is possible to consider this as an alternative treatment strategy for osteocutaneous free flap in anterior segmental defects.

Comparison of Functional and Survival Outcomes in Pedicled and Microsurgical Flap Reconstruction for Near-Total and Total Glossectomies.

Introduction:Patients with advanced carcinoma tongue end up with near-total/total glossectomy (NTG/TG). We intended to compare functional, oncological, and survival outcomes of patients undergoing pedicled and microsurgical flap reconstruction in NTG/TG patients at our hospital.Methodology:A prospective study was conducted for 7 years on 91 patients with carcinoma tongue who underwent NTG/TG at our institute. Patients underwent anterolateral thigh (ALT), free radial artery forearm flap (FRAFF), and pectoralis major myocutaneous (PMMC) flap reconstruction and were followed up for immediate complications and functional outcomes for speech, swallowing, and decannulation after completion of adjuvant treatment and then for survival rates for a period of 60 months and statistically analysed with log rank test and Fisher’s exact test for correlation.Results:Ninety-one (42.85%) patients underwent NTG, while 57.14% underwent TG. 85% of patients had >5 mm margin, 14% had ≤ of 5 mm, and none were positive. 57% of patients did not have postoperative complications and 10% underwent re-exploration. During follow-up, 85.7% of patients were able to take orally: 52% soft diet and 32% liquid diet. Multivariate analysis of individual flaps, swallowing, and speech intelligibility values were significant. After 5 years of postadjuvant therapy, there was 76% overall survival, 11% local recurrence and 12% had regional recurrence.Discussion:Morbidity and functional outcome depends on the extent of resection. PMMC flaps can be done on lack of expertise. FRAFF has better functional outcomes owing to pliability of flap. ALT and other bulky flaps require expertise and are prone to flap-related complications. Planning of reconstruction should be based on the defect size together with counseling of patients regarding the risk of complications and delay in adjuvant therapy.

Giant Thyroid Mass Excision Using Energy Device and Pectoralis Major Myocutaneous Flap Reconstruction

Giant Thyroid Mass Excision Using Energy Device and Pectoralis Major Myocutaneous Flap Reconstruction

Alternatives to free flap surgery for maxillofacial reconstruction: focus on the submental island flap and the pectoralis major myocutaneous flap

BackgroundMicrovascular tissue transfer (MTT) has been established as the gold standard in oral- and maxillofacial reconstruction. However, free flap surgery may be critical in multimorbid elderly patients and after surgery or radiotherapy, which aggravate microsurgery. This study evaluates indications and outcome of the submental island flap (SMIF) and the pectoralis major myocutaneous flap (PMMF) as alternatives to the free radial forearm flap (RFF).MethodsThis retrospective study included 134 patients who had undergone resection and reconstruction with SMIF, PMMF, or RFF at our department between 2005 and 2020. The level of comorbidity was measured with the Age-adjusted Charlson comorbidity index (ACCI). Primary outcome variables were flap success, complications, wound dehiscence, surgery duration, as well as time at the ICU and the ward (hospitalization). Chi-square tests, t-tests, and ANOVA were performed for statistics.Results24 SMIFs, 52 RFFs, and 58 PMMFs were included in this study. The flap types did not significantly differ in terms of flap success, complications, and healing disorders. The SMIF presented a success rate of 95.8% and was significantly more often used in elderly patients (mean age = 70.2 years; p < 0.001) with increased comorbidities than the PMMF (p < 0.01) and RFF (p < 0.001). SMIF reconstruction reduced surgery duration (p < 0.001) and time at the ICU (p = 0.009) and the ward (p < 0.001) more than PMMF and RFF reconstructions. PMMF reconstruction was successful in 91.4% of patients and was more frequently used after head and neck surgery (p < 0.001) and radiotherapy (p < 0.001) than SMIF and RFF reconstructions. Patients undergoing PMMF reconstruction more frequently required segmental jaw resection and had presented with advanced tumor stages (both p < 0.001). Nicotine and alcohol abuse was more frequent in the RFF and PMMF groups (both p < 0.001) than in the SMIF group.ConclusionsThe pedicled SMIF represents a valuable reconstructive option for elderly patients with increased comorbidity because of the shorter duration of surgery and hospitalization. On the other hand, the PMMF serves as a solid backup solution after head and neck surgery or radiotherapy. The rates of flap success, complications, and healing disorders of both pedicled flaps are comparable to those of free flap reconstruction.

Analysis of the efficacy of the pectoralis major myocutaneous flap in reconstructive head and neck surgery

IntroductionAlthough free flaps have been used predominantly in past decades for the soft tissue reconstruction of head and neck malignancies, Pectoralis major myocutaneous flap (PMMF) is still a reliable workhorse for patients with co-existing co-morbidities or low economic status where free flaps are not feasible. Patients and methodsIt was a retrospective study done on 36 patients of head and neck malignancies over the period of 5 years in which PMMF was used as a method of reconstruction in our hospital. Patients were followed up for a period of one year and outcome of PMMF was evaluated. ResultsOut of 36 patients 31 were of oral cancer and 5 were of carcinoma hypopharynx. Incidence of total flap necrosis was nil and partial flap necrosis was 16.6%. Orocutaneous fistula was found in 16.6%, wound dehiscence was in 19.4% and infection was found in 13.5% of patients. Non-flap related complications were found in 13.8% of patients. 35 out of 36 patients (97.2%) eventually achieved satisfactory surgical outcome of PMMF reconstruction. ConclusionPMMF is a reliable method of reconstruction for head and neck malignancies especially in basic healthcare settings. With minimal expertise and groundwork, it is still a cost-effective workhorse flap for head and neck reconstruction.

Bilobed Pectoralis Major Myocutaneous Flap Reconstruction: a Single Institution Experience of 150 Patients and Methods to Prevent Complications.

Bilobed PMMC flap is done for patients who have diseases that require resection of oral cavity mucosa along with the overlying skin, either because of direct tumor invasion to the skin or for achieving adequate tumor-free base of resection. The versatility of the flap allows it to be used to cover both inner and outer linings for a full-thickness defect. This was a single-center, retrospective, observational study carried out in the Department of Head and Neck Oncology at a regional cancer center from January 2019 to December 2019. A minimum follow-up duration for all patients was 6months. The primary endpoint was to study the results and complications associated with bilobed PMMC flap reconstruction and factors affecting it, as well as their management. The median age was 45years [24-71years]. There were 96(64%) males and 54(36%) females. The most common sites reconstructed were lower gingivobuccal sulcus (39.1%), buccal mucosa (30.2%), and lower alveolus (16.7%). The overall complication rate was 41.3%, with 10(6.6%) patients requiring re-exploration. The average hospital stay was 11days [5-28days]. On doing a multivariate analysis, for various factors affecting flap necrosis, none of the factors reached statistical significance (p value > 0.05). PMMC flap remains the workhorse of head and neck reconstruction. In cases of full-thickness defects in oral cancer patients, in our country, in the setup which lacks the expertise in microvascular anastomosis and with immense caseload in the head and neck cancer department, bilobed PMMC flap remains a safe and favorite alternative method for reconstruction.

Incidentally detected anomalous pectoralis major muscle during reconstruction of oral cavity cancer

The congenital deficiency of pectoralis major muscle is quite uncommon. Only a few cases are described in the literature that too in cadavers. Recently, we came across a case of deficient pectoralis major while harvesting pectoralis major myocutaneous (PMMC) flap for reconstruction following right composite resection for carcinoma of the right buccal mucosa in a 50-year-old female. The external appearance of the anterior chest wall was normal. During surgery, we found that the clavicular head and sternal portion of the sternocostal head of the right pectoralis major muscle were absent and the costal portion of the sternocostal head was deficient over the medial aspect. A normal pectoralis minor was present. This deficiency may be congenital in nature. We present this case to highlight this uncommon condition, and this may be the only case report till now wherein deficient pectoralis major was used for PMMC flap reconstruction of oral cavity defect.

The folded, bipaddled pectoralis major myocutaneous flap for complex oral cavity defects: Undiminished relevance in the era of free flaps

SummaryOral cancer often presents at an advanced stage, requiring extensive resection and complex reconstruction, such as free tissue transfers, which may not be available in a remote or resource-constrained facility. The common alternative in these cases is the use of the workhorse flap, the pectoralis major myocutaneous (PMMC) flap for lining and a second regional flap for cover. The results are variable, increase operative time and cost, and may cause additional donor site morbidity.We present a series of patients who underwent reconstruction for complex oral cavity and neck defects with a single PMMC flap with a unique design, folded or bipaddled to serve as both lining and cover. Pre- and post-operative data pertaining to patients with oral cancer who were selected to undergo bipaddled PMMC flap reconstruction in our unit between January 2017 and July 2019 were collected and analysed.Of the 41 patients, 28 were males and 13 were females. The surgical resection involved full-thickness excision of primary tumour and involved skin (face or neck) for oral cancers. The size of skin paddle harvested ranged from 8 to 15 cm horizontally to 6 to 22 cm vertically. Usually, the distal part of the skin paddle formed the mucosal lining and the proximal formed the skin cover. Complication rates in the immediate postoperative period and on initial follow-up visits were comparable to a conventional PMMC flap.Reconstruction of complex head and neck defects requiring mucosal lining and skin cover can be achieved with a single stage, bipaddled PMMC flap, a reliable and easily learnt alternative to technically demanding free tissue transfers. The complication rate observed in our series is remarkably low, even in females. With a proper design of the flap and appropriate orientation of the skin paddle, excellent results can be achieved with a bipaddled PMMC flap.