To evaluate functional oral intake and patient-reported dysphagia, neck disability, and symptom-specific health-related quality of life (HRQOL) amongst patients who underwent pectoralis major myocutaneous flap (PMMF) versus microvascular free flap reconstruction after salvage laryngectomy. Retrospective analysis of prospectively collected data. Multidisciplinary head and neck cancer (HNC) Survivorship clinic. Patients with at least 6 months of postoperative follow-up from salvage total laryngectomy/total laryngectomy with partial pharyngectomy and subsequent PMMF or free flap reconstruction were included. Patients who underwent total laryngo-pharyngectomy, with recurrence, with metastatic disease, and/or with missing data were excluded. Functional Oral Intake Scale (FOIS) and validated patient-reported outcome measures, including Eating Assessment Tool-10 (EAT-10), Neck Disability Index (NDI), and measures of pain-, swallowing-, and shoulder-specific University of Washington Quality of Life (UW-QOL) subscale scores. Twenty-four patients underwent PMMF, and 30 patients underwent microvascular free flaps. Mean EAT-10, NDI, and pain-, swallowing-, and shoulder-specific UW-QOL subscale scores were not significantly different between these two groups. Mean FOIS was slightly higher in patients reconstructed with PMMF (5.67 ± 1.52 vs. 4.57 ± 2.12), p = 0.047, but the clinical relevance of this finding is unclear. Patient-reported outcomes pertaining to dysphagia, neck disability, and pain-, swallowing- and shoulder-specific HRQOL did not vary significantly between patients reconstructed with PMMF versus microvascular free flap. Future studies with larger cohorts are required to further establish differences in functional outcomes between reconstructive approaches following salvage laryngectomy.

Full thickness defects of the oral cavity present a challenge to the surgeon for reconstruction. The advent of microsurgical vascular anastomosis has led to acceptance of free flaps as reconstructive procedures of choice for such patients. But financial constraints and resource limited settings can force us to fall back on the ever-reliable Pectoralis major myo-cutaneous (PMMC) flap. The present study aspires to analyze the complications and functional outcomes of reconstruction with bi-folded PMMC flaps in female patients. Retrospective analysis of the data of 60 female patients who were reconstructed with bi-folded PMMC flaps over a period of 2 years between July 2020 and June 2022 was done. Data was analyzed in terms of patient factors, flap-related complications, and functional outcomes. The overall complication rate including major/minor complications was 46.6% with flap detachment at 23.3% being the commonest complication observed. A total of 16.6% patients developed an Oro-cutaneous fistula and surgical site infection was seen in 11.66%. A total of 5% patients suffered a complete flap failure, whereas 11.66% suffered a partial flap failure. A total of 11.66% patients suffered from oral commissural incontinence and needed a redo commissuroplasty. Overall 33.33% patients were subjected to a second surgical intervention. Only 3.33% patients suffered from total inability to swallow liquids or solids. Only 6.66% patients had a completely unintelligible speech post operatively. The PMMC flap is a robust, dependable, and economical option for reconstruction of oral cavity defects with acceptable functional outcomes in settings where the microvascular surgical facilities are unavailable or are unaffordable.

IntroductionThe head and neck defects have multiple reconstructive options available among which pectoralis major myocutaneous flap has remained a reliable option for reconstruction. This study aimed to evaluate outcome of pectoralis major myocutaneous flap reconstruction in head and neck surgery. MethodsThis is a retrospective observational study done by analyzing the clinical records of 29 cases with reconstruction of head and neck defects due to various etiologies with PMMC flap from January 2021 to December 2025. The data were analyzed using IBM SPSS statistics version 25. ResultsOut of 29 cases, 21 were males and 8 were females. The most common pathology was squamous cell carcinoma (SCC) (n=27) (93.1%) that involved gingivobuccal sulcus in 12 cases (41.37%). It was followed by buccal mucosa (20.68%), floor of mouth (13.79%), one case each of lip and angle of left mandible (3.45%), tongue (10.34%) and retromolar trigone (6.9%). The PMMC flap had 100% survival rate no partial or total flap loss. However, the flap had complication rates of 34.48% in this study. Gingivobuccal sulcus accounted for most of the complications including four cases (13.79%) and it was followed by two cases each of buccal mucosa and floor of mouth (6.89%), one case each of tongue and lip (3.44%). ConclusionThe PMMC flap showed complications like wound dehiscence, seroma and surgical site infection. However, it showed promising result regarding its survival rate and coverage of defects in head and neck.

This study presents a systematic summary of composite tissue flap reconstruction strategies centered on the versatile anterolateral thigh (ALT) flap for complex orofacial defects. Through a retrospective analysis of 21 patients (mean age 56.4 years) at a single center, it details the rationale, surgical protocol, and outcomes of four synergistic flap combinations. These include: 1) ALT with pectoralis major myocutaneous flap for large oropharyngeal-cervical through-and-through defects; 2) ALT with fibular osteomyocutaneous flap for composite mandibular and soft tissue defects; 3) ALT with free auricular composite flap for combined large soft tissue and specialized subunit (e.g., alar rim) defects; and 4) double ALT flaps for extensive, three-dimensionally complex soft tissue defects. The procedural framework elaborates on precise indication selection, anatomical design based on perforator mapping, meticulous sequential flap harvest via standardized approaches, and key technical aspects of microvascular anastomosis. Representative results from the cohort demonstrated a 100% flap survival rate. Postoperative complications were manageable (9.5%), including one orocutaneous fistula and one donor-site seroma, neither compromising final outcomes. The findings establish a practical, individualized clinical framework that integrates reliable surgical techniques with functional-aesthetic goals, offering a practical and adaptable approach for the precise reconstruction of severe, multifaceted orofacial defects.

Objective: To investigate the feasibility of radical surgery for cervical esophageal cancer (CEC) invading the membranous part of the trachea and the optimal strategies for posterior tracheal wall reconstruction. Methods: A retrospective analysis was conducted on the clinical data of 7 patients with CEC invading the membranous part of the trachea who were admitted to the First Affiliated Hospital of Zhejiang University School of Medicine from March 2020 to March 2024. All 7 patients were male, with an age range of 49 to 69 years. Two cases were primary CECs involving the cervical tracheal membranous part; three cases were recurrent CECs after chemo-radiotherapy involving the tracheal membranous part, among which two had tracheoesophageal fistula (TEF); one case developed TEF after esophageal replacement with a gastric tube following CEC surgery; and one case was recurrent CEC involving the tracheal membranous part and complicated with TEF after surgery. All cases were discussed by a multidisciplinary team (MDT) to determine the optimal treatment plan. This study focused on the surgical plan design, posterior tracheal wall reconstruction techniques, and therapeutic efficacy. Results: All 7 patients successfully underwent tumor resection and posterior tracheal wall reconstruction. Four cases which underwent total laryngectomy, total hypopharyngectomy, and total esophagectomy were reconstructed by gastric tubes and pectoralis major myocutaneous flaps, using supraclavicular artery island flaps or strap muscle flaps to reconstruct the posterior tracheal wall. One case retained laryngeal function after gastric tube reconstruction and repairment of the membranous part of the trachea with a strap muscle flap. Two cases with postoperative TEF were repaired with vascularized flaps (one repair failed and the patient subsequently underwent stent implantation). The follow-up period ranged from 12 to 58 months, with five patients surviving free of recurrence and two patients dying at 25 and 42 months postoperative, respectively. The success rate of tracheal reconstruction was 100%, and six patients resumed oral feeding. Conclusion: Performing gastric tube reconstruction combined with vascularized tissue flaps (such as supraclavicular artery island flaps or strap muscle flaps) for primary reconstruction of the posterior tracheal wall is a safe, feasible, and effective radical strategy for treating CEC invading the tracheal membranous part.

Objective: To evaluate the efficacy of a surgery based multimodal therapy for locally advanced resectable cervical esophageal squamous cell carcinoma, focusing on surgical indications, selection of resection and reconstruction methods, and factors influencing prognosis. Methods: A retrospective analysis was conducted on the clinical data of 117 patients with primary cervical esophageal squamous cell carcinoma treated at Department of Head and Neck Surgery, Shandong Ear-Nose-Throat Hospital from September 2014 to October 2023. The cohort consisted of 93 males and 24 females, aged from 45 to 77 years. There were 35 cases with T1-T2 stage and 82 cases with T3-T4 stage. Gastroscopy screening upon admission identified synchronous middle-inferior esophageal carcinoma in 11 cases and synchronous hypopharyngeal cancer in 4 cases. Treatment regimens were as follows: surgery with postoperative adjuvant radiotherapy in 72 cases; surgery with adjuvant concurrent chemoradiotherapy/radiotherapy plus targeted therapy in 7 cases; neoadjuvant chemotherapy (or with immunotherapy) followed by surgery and postoperative radiotherapy in 7 cases; neoadjuvant concurrent chemoradiotherapy or planned preoperative radiotherapy followed by surgery in 6 cases; and surgery alone or incomplete postoperative radiotherapy in 25 cases. Total laryngectomy was performed in 112 patients, while, 5 patients retained laryngeal function. The main reconstruction methods included free jejunal graft in 26 cases and gastric pull-up with pharyngogastric anastomosis in 91 cases. Among these, one patients underwent free jejunal graft combined with middle and lower esophageal resection, while two patients with gastric pull-up combined with free skin grafts, one patient combined with pectoralis major myocutaneous flaps, and one patient combined with free jejunal grafts reconstruction. Clinical data were analyzed using SPSS 25.0 software. Results: Follow-up was completed until Feb 2025. Eighty seven patients competed 3-year follow-up. Sixty one patients completed 5-year follow-up. The 3-year and 5-year overall survival rates were 65.0% and 50.5% calculated by the Kaplan-Meier method. Fifty patients died during follow-up, among whom 28 (56.0%) patients died from distant metastases. One patient died perioperatively. Major complications included partial gastric necrosis (n=1), vascular thrombosis of the jejunum graft requiring a second jejunal graft reconstruction (n=1) or salvageable gastric pull-up (n=1), pharyngeal fistula (n=10), severe pulmonary infection (n=3), cervical hemorrhage (n=2), pharyngeal fistula leading to pharyngogastric anastomotic stricture (n=2), and pleural effusion (n=5). Multivariate analysis revealed that T3-T4 stage,N2-N3 stage and stage Ⅲ-Ⅳ diseases were independent prognostic factors (all P<0.05). Conclusions: Surgery-based multimodal therapy for cervical esophageal squamous cell carcinoma provides favorable local control and overall survival. Free jejunal graft and gastric pull-up are the most common reliable reconstructive approaches. Multidisciplinary comprehensive treatment is crucial to ensure surgical safety and efficacy.

Combined Pectoralis Major Myocutaneous Flap (PMMC) and Deltopectoral Flap (DP) for Pharyngeal and Neck Defect After Total Laryngectomy: A Case Series from Tertiary Care Centre

Transoral robotic surgery is increasingly used for selected base-of-tongue tumours, but is often impractical in patients with severe trismus and remains cost prohibitive. Conventional transmandibular approaches are associated with significant morbidity. We describe a transpharyngeal technique incorporating hyoid suspension to address these limitations. A retrospective series of patients undergoing transpharyngeal resectionfor base-of-tongue carcinoma is presented. The technique includes neck dissectionwith vascular control, lateral-inferior pharyngotomy, tumour excision under direct visualisation and reconstruction with pectoralis major myocutaneous flap with routine hyoid suspension. Hypoglossal nerve preservation was undertaken where oncologically appropriate. Fifteen previously untreated patients were treated, including 12 with severe trismus. Clear margins were achieved in 13 cases. Reconstruction was performed with a pectoralis major myocutaneous flap in 13 patients. Most patients achieved decannulation and oral feeding within 30 days. Transpharyngeal resectionwith hyoid suspension is a feasible and cost-effective alternative to transoral robotic surgery in selected base-of-tongue cancers, particularly in patients with severe trismus.

Tattooing in the general population has become increasingly popular in recent years. Tattoo ink may contain carcinogenic chemicals, and long-term health risks remain a concern. When any proposed surgical intervention violates a tattooed area, such as where a tattoo is located in a planned donor site of a workhorse flap, the physical, cosmetic, and psychological effects of both recipient and donor sites on a patient must always be considered. In this study, we aimed to develop alternative options for microsurgeons when faced with planned donor sites for workhorse flaps covered with tattoos. Our objective was to avoid tattooed flap transfer to head and neck defects while preserving patients' personal tattoos as a patient-centered concept. We retrospectively reviewed 12 patients between January 2020 and December 2024. All the patients were males with an average age of 51.4 years (11 patients with oral cancer and 1 patient with trauma). All the patients had tattoo at donor sites of workhorse flaps. When we faced such conditions, our strategies included the following: option 1, selecting different flaps that have no tattoo area; and option 2, selecting flaps that would not violate a tattoo, using the concept of freestyle flaps as alternative options for preserving a tattoo in a tattooed donor site. We transferred nontattooed flaps to a recipient area in all the patients. Nine free flap transfers were performed, including 2 free superficial circumflex iliac artery flaps, 4 anterolateral thigh flap, 1 fibula osteocutaneous flap, 1 anteromedial thigh flap, and 1 medial sural artery perforator flap. Three locoregional flaps were 2 distally based sural flaps and 1 pectoralis major myocutaneous flap. All the flaps were designed to preserve the tattoos. All the transferred flaps were successful. Donor-site defects were primarily closed in 8 patients, whereas the other 4 required skin grafts. When surgeons face donor sites of usual workhorse flaps covered with tattoos, strategies include selecting flaps from different donor sites without tattoos or using the concept of freestyle flaps as alternative options for preserving the tattoo to achieve a better result for the patient.

&lt;b&gt;Introduction:&lt;/b&gt; Oral squamous cell carcinoma (OSCC) is the most common malignancy of the oral cavity and often requires extensive resection with reconstruction. Fibula free flap (FFF) is the preferred bony reconstructive option in head and neck oncology, as failure rates are the lowest of all free flaps. Late FFF failure in the era of intensity-modulated radiotherapy (IMRT) is rare. &lt;br&gt;&lt;br&gt;&lt;b&gt;Case report:&lt;/b&gt; Fourty-four-year-old male smoker, diagnosed with G2 OSCC. He underwent tumour resection, partial glossectomy, mandibular reconstruction with an osteomyocutaneous FFF and adjuvant IMRT. After 4 years, he experienced total flap failure due to mandibular osteoradionecrosis (ORN), necessitating a salvage pectoralis major myocutaneous (PMMC) flap. &lt;br&gt;&lt;br&gt;&lt;b&gt;Discussion:&lt;/b&gt; Late FFF failure in IMRT is sporadic. This case highlights the synergistic effects of smoking-related vascular compromise and radiotherapy-induced hypoxia and hypocellularity as the pathophysiology behind flap failure. The choice of PMMC for salvage procedure is discussed in the context of its clinical implications, along with the importance of adhering to long-term follow-ups and mitigating risk factors for high-risk patients to improve patient quality of life. &lt;br&gt;&lt;br&gt;&lt;b&gt;Conclusions:&lt;/b&gt; In modern medicine with advanced radiation therapy techniques, every case of FFF failure is a learning opportunity to improve patient care. The importance of long-term surveillance and structured smoking cessation support is crucial to optimise health care outcomes and preserve quality of life for head and neck cancer patients.

Abstract Background Oral cancer reconstruction often overlooks aesthetic and psychological outcomes, impacting patients’ quality of life. Bipaddle Pectoralis Major Myocutaneous Flap (PMMC) is an effective alternative to traditional methods. Purpose The study aims to highlight both the functional benefits and the positive impacts on patients’ aesthetic and psychological well-being, emphasising the importance of confidence, social acceptance, and mental health in reconstruction outcomes. Materials and Methods A retrospective observational study was conducted on 50 OSCC patients who underwent tumour resection followed by reconstruction with bipaddle PMMC flaps in the Department of Surgical Oncology from September 2022 to October 2024. Patients were assessed at 6 and 12 months postoperatively using multiple validated instruments, including FACE-Q, Patient and Observer Scar Assessment Scale (POSAS), Derriford Appearance Scale-24 (DAS-24), Functional Assessment of Cancer Therapy–Head &amp; Neck (FACT-H&amp;N), and European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 with H&amp;N35 module. Results At 12 months, significant improvements were observed in scar quality, with mean POSAS scores decreasing, indicating better healing and cosmetic appearance. FACE-Q domains related to facial appearance, psychological well-being, social function, and eating function showed marked improvement. DAS-24 scores demonstrated reduced appearance-related distress, anxiety, and self-consciousness. FACT-H&amp;N and EORTC QLQ-C30/H&amp;N35 scores reflected enhanced physical, functional, and social well-being. Strong positive correlations were noted between FACE-Q and FACT-H&amp;N (ρ = 0.72), FACE-Q and QLQ-C30 (ρ = 0.75), and a significant inverse correlation between FACE-Q and DAS-24 (ρ = -0.68). Conclusion Bipaddle PMMC flap reconstruction following oral cancer resection offers substantial aesthetic and psychosocial benefits, with improved functional outcomes at one year. This technique remains an effective and reliable option for complex head and neck defects, particularly where microvascular free tissue transfer is not feasible.

Persistent tracheocutaneous fistula closure by pectoralis major myocutaneous flap: surgical technique

Objective: The aims of study to evaluate the functional and aesthetic outcomes of various local and regional flaps used for immediate reconstruction of oro-mandibular defects following tumor resection in Hadhramout National Oncology Center. Methods: This prospective study of 156 patients with Stage I–III oral, mandibular, or oro-mandibular tumors, predominantly squamous cell carcinoma (91.7%), underwent immediate reconstruction at Hadhramout National Oncology Center from January 2013 to March 2025. Flaps included local tongue and buccal flaps, pectoralis major myocutaneous (PMMC), submental, nasolabial, temporal, deltopectoral, forehead, and bilateral Karapandzic flaps. Functional and cosmetic outcomes were assessed preoperatively and six months postoperatively using the University of Washington Questionnaire. Statistical analysis (Chi-square test, Cramer’s V) was performed to evaluate associations between flap type and postoperative outcomes. Results: Among 156 patients (96 males, 60 females; mean age: 52 years), squamous cell carcinoma predominated (91.7%). Soft tissue defects were most common (62.2%), and local flaps were the most frequently used (34.6%). The overall flap success rate was 98.1%. Functional outcomes were significantly associated with flap type (χ²(7)=105.026, p&lt;0.001; Cramer’s V=0.82). Submental, PMMC, and local flaps yielded the highest rates of excellent functional outcomes. Aesthetic outcome was also significantly associated with flap type (χ²(9)=18.863, p=0.026; Cramer’s V=0.35), with nasolabial and local flaps performing best. Complications, including partial flap loss (1.3%) and orocutaneous fistula (1.3%), were minimal. Statistical analysis revealed significant associations between flap type and outcomes, with local and submental flaps excelling in both function (p &lt; 0.001) and aesthetics (p = 0.026). Conclusion: This study underscores the viability of pedicled flaps particularly PMMC and submental flaps in settings lacking microsurgical infrastructure, offering reliable functional and cosmetic reconstruction of oro-mandibular defects while maintaining acceptable morbidity and quality-of-life outcomes. These techniques provide viable alternatives to free flap reconstruction and support extensive oncologic resection without compromising postoperative quality of life

Dysphagia after total laryngectomy is rare.Even when it occurs, it often improves with bougienage or endoscopic treatment by an otolaryngologist.However, in the present case, the patient's dysphagia was severe and progressive owing to the effects of radiation therapy, prompting consultation with reconstructive surgery.The contracted pharyngeal mucosa was released under direct visualization, and well-vascularized flap transplantation was performed.Pectoralis major myocutaneous flap reconstruction using a strip of the posterior pharyngeal mucosa has maintained a good swallowing function over the long term.

A comparison of outcomes between the angiosome-capturing extended (ACE) technique and conventional technique for the pectoralis major myocutaneous flap for oral cavity defects

To explore the feasibility and effectiveness of repairing surgical defect in pharyngo-laryngeal malignant tumor with free rectus femoris flap. The clinical data of 34 patients with surgical defects in pharyngo-laryngeal malignant tumor who met the selection criteria between July 2014 and August 2024 were retrospectively analyzed. There were 25 males and 9 females, aged 25-82 years, with a median age of 54 years. The disease duration ranged from 2 months to 2 years, with a median of 7 months. The tumor locations included the oropharynx, hypopharynx, cervical esophagus, and larynx. Pathological types included squamous cell carcinoma (29 cases), myoepithelial carcinoma (2 cases), adenoid cystic carcinoma (1 case), and diffuse large B-cell lymphoma (2 cases). TNM staging: 16 cases of T 4N 1M 0, 3 cases of T 4N 2M 0, 3 cases of T 4N 0M 0, 10 cases of T 3N 1M 0, and 2 cases of T 3N 0M 0. The 2017 American Joint Committee on Cancer (AJCC) staging was stage Ⅲ in 2 cases and stage Ⅳ in 32 cases. The blood supply of the proximal rectus femoris muscle was observed by enhanced CT of the lower limb vessels before operation, and the surgical defects ranged from 3.0 cm×2.0 cm to 12.0 cm×8.5 cm. The blood supply and perforators of rectus femoris muscle were explored during operation, and the free rectus femoris flap pedicled with the direct vascular stem of rectus femoris muscle was used to repair the defect. For the patients with pharyngeal fistula or obvious neck swelling after operation, the blood supply of the flap was analyzed by vascular enhanced CT to determine the corresponding strategies of nutritional support, anti-infection, dressing change and drainage. Radiotherapy and chemotherapy were supplemented in 27 patients with lymph node metastasis after operation. All the 34 patients were followed up 1-10 years, with an average of 3 years. The flap was found to be necrotic by fibrolaryngoscopy at 1 week after operation in 2 cases, and the incision healed after dressing change and nutritional support, and no reoperation was performed. The flap was in good condition at 1 week after operation in 4 cases, and the signs of gradual necrosis of the flap were found within 1 month after operation, of which 2 cases were healed after dressing change, 1 case was removed the necrotic tissue by reoperation, and 1 case was healed after pectoralis major myocutaneous flap was used to repair the pharyngeal tissue defect. The flaps survived in 28 cases, including 4 cases of pharyngeal fistula, which healed by dressing change. Twenty-two cases achieved satisfactory results in swallowing or phonation. Two patients with total laryngectomy and voice reconstruction underwent reoperation to seal the voice tube because of postoperative aspiration. During the follow-up, 1 case had tracheal stomal recurrence, 2 cases had bone metastasis, and 1 case had bone and lung metastasis. The free rectus femoris flap has good flexibility, the volume of the flap is easy to adjust, and the incision of the donor site is concealed, which is expected to become a new choice for the repair of the surgical defect in pharyngo-laryngeal malignant tumor.

Mammoplasty-Driven Pectoralis Major Myocutaneous Flap for Oral Cavity Defect Reconstruction in Female Oral Cancer Patients: A Novel Technique Preserving Aesthetics at 2 Sites.

enlargement (Figs 2 and3).Chest X-ray and CT chest showed no abnormality.Core needle biopsy performed twice from the lesion was inconclusive.The case was discussed in a multidisciplinary tumor board, and in view of clinical and radiological features suspicious of malignancy, surgical intervention was planned.Intraoperatively, the tumor was of rubbery consistency, resembling sarcoma, with skin and bone (right lower alveolus) involvement and intact FOM mucosa.The tongue was not involved.Based on the extent of the tumor, right composite resection with dual flap (pectoralis major myocutaneous flap and deltopectoral flap) reconstruction was done (Fig. 4).Postoperative recovery was uneventful.Postoperative histopathology revealed OFMT with free resected margins.No cervical lymph node involvement was noted (IHC study: S100, desmin focal positive).

This retrospective study compared Pectoralis Major Myocutaneous (PMMC) flap reconstruction and primary closure in eight patients undergoing Commando surgery for lower alveolus carcinoma. PMMC reconstruction yielded better speech, swallowing, and wound healing outcomes but required longer hospital stays and resulted in bulkier aesthetics. Primary closure was quicker with shorter hospitalization but was associated with higher complication rates, making PMMC the preferred option for larger defects.

Malignant solitary fibrous tumor (MSFT), a rare mesenchymal malignancy with aggressive local infiltration and metastatic propensity, poses significant therapeutic challenges in the head and neck region. Locally advanced cases requiring extensive resection necessitate reliable reconstruction strategies to balance oncologic control and functional preservation. We conducted a retrospective analysis of 7 consecutive patients with T3/T4N0-2M0 head and neck MSFT undergoing radical resection and immediate pedicled pectoralis major myocutaneous flap (PMMF) reconstruction (2017-2024). Outcomes included surgical parameters, University of Washington Quality of Life (UW-QoL) scores at 6 months, and disease-free survival (DFS). All patients achieved R0 resection with 100% flap survival. Mean operative time was 276±24 minutes, with no major complications (Clavien-Dindo ≥III). UW-QoL scores demonstrated significant functional recovery: pain control (75.6±3.2), swallowing (78.6±5.1), and speech (95.7±2.4), with total scores exceeding 800/1200 in all cases. Over a mean follow-up of 35.1 months (range: 6-84), DFS was 100%. Four high-risk patients received adjuvant radiotherapy (50-70Gy) without acute toxicity. PMMF reconstruction provides a technically accessible solution for locally advanced head and neck MSFT, enabling radical tumor clearance while optimizing functional rehabilitation and QoL. The absence of microvascular anastomosis and a low morbidity profile make it particularly suitable for resource-constrained settings. Prospective multicenter studies are needed to validate these findings.