Pectoralis Major Myocutaneous Flap Research Articles

Assessing Complications and Outcomes of Pectoralis Major Myocutaneous Flap in Head and Neck Oncology: Insights from 150 Cases

Assessing Complications and Outcomes of Pectoralis Major Myocutaneous Flap in Head and Neck Oncology: Insights from 150 Cases

Dumbbell Shaped Bi-Paddled Pectoralis Major Myocutaneous Flap (PMMF) for Composite Commissural Defects: A Defect Driven Modification

Pectoralis major myocutaneous flap (PMMF) has been a workhorse in orofacial reconstruction. Although microvascular tissue transfer has gained popularity in major tertiary centres, several infrastructural factors limit its use in many facilities, particularly in developing countries with high caseloads. Numerous modifications have been made to the PMMF since its inception. Here, we present a novel technique for reconstructing composite commissural defects with PMMF by modifying the skin paddle design to a dumbbell shape. Both ends of the paddle are used to line intraoral and extraoral defects, while the constricted middle portion recreates the commissure. We report the outcomes of a cohort of seven patients treated at our institution, describing the modified PMMF design, harvesting, and in-setting techniques used in oral carcinoma cases involving the commissure. We have detailed the study outcomes for each patient, including the various complications related to the flap, donor, and recipient sites.

Pharyngostoma reconstruction after laryngectomy and radiotherapy: A retrospective study and literature review

BackgroundThe occurrence of pharyngocutaneous fistula or pharyngostoma after oncologic head and neck surgery is a serious complication. It is the most common complication after major hypopharyngeal and laryngeal ablative surgery. AimThe purpose of this study is to review the surgical approach and evaluate the results regarding reconstruction methods of pharyngostoma, caused after laryngectomy and radiotherapy. Patients & MethodsThe total patient number is 15. Pharyngostoma caused swallowing difficulties, as well as frequent aspiration pneumonia. The intervention interval from laryngectomy to pharyngeal reconstruction varied between one to three years, depending on the symptoms’ severity and after the complete failure of conservative rehabilitation methods. Pharyngostoma reconstruction was performed mainly with pectoralis major myocutaneous flap in eleven cases. The radial forearm free flap (RFF) and the anterolateral thigh free flap (ALT) were also used in the rest four cases. ResultsThe postoperative course was uncomplicated and in most cases the feeding with soft food started after a barium meal between 15-20 days postoperatively. Complications include wound dehiscence and leak treated conservatively and one case of carotid rupture. ConclusionsThe gold standard for pharyngostoma reconstruction, after laryngectomy and cervical radiotherapy, remains the use of pectoralis major myocutaneous flap. In cases of extensive neck radionecrosis free flaps are preferable. Reliable and stable cover of the large vessels of the neck beside with the reconstruction of the digestive tract and the function of swallowing are issues, which are analysed in corelation with the avoidance of stenosis and swallowing difficulties.

Pectoralis Major Myocutaneous Flap in Reconstruction after Salvage Laryngectomy

Pectoralis Major Myocutaneous Flap in Reconstruction after Salvage Laryngectomy

Thoracoabdominal Flap Closure for Large Post Pectoralis Major Myocutaneous Flap Donor Site in Advanced Oral Cancer: An Innovative Approach in Resource Constraint Setting

Thoracoabdominal Flap Closure for Large Post Pectoralis Major Myocutaneous Flap Donor Site in Advanced Oral Cancer: An Innovative Approach in Resource Constraint Setting

Management of thoracic aortic graft infections with combined omental and bilateral pectoralis major flaps

BackgroundAortic vascular graft/endograft infection (VGEI) has historically been managed through graft removal and re-replacement, but new approaches suggest vascularized tissue transfer is an effective adjunctive treatment. Here we describe our experience with treating thoracic aortic vascular graft infection with combined omental and bilateral pectoralis major myocutaneous (PMM) advancement flaps. MethodsAll patients undergoing combined flap closure by the senior author at a high-acuity cardiac surgery center from 1995-2023 were reviewed. Patients with clinical and radiographic signs of thoracic aortic vascular graft infection were included. ResultsComplete data were available for 598 patients with sternal and mediastinal wounds. Combined PMM and omental flaps were mobilized in 11 thoracic aortic vascular graft infection patients. Indications for flap management included culture-positive infection (8/11; 72.7%), dehiscence (5/11; 45.5%), drainage (7/11; 63.6%), and inability to close the sternotomy due to hemodynamic instability (5/11; 45.5%). During chest exploration, 6/11 (54.5%) underwent complete removal of the infected graft, compared to 5/11 (45.5%) who underwent graft-preserving washout and debridement. Immediate flap closure was performed in 6/11 (54.5%). Post-op complications included dehiscence (2/11; 18.2%), seroma (1/11; 9.1%), hematoma (1/11, 9.1%), abdominal hernia (1/11; 9.1%), and recurrent infection (1/11; 9.1%). One patient (9.1%) died within 30 days of sternal reconstruction from mitral valve failure tachyarrhythmia. None has undergone reoperation for flap-related complications. ConclusionsDespite significant comorbidities, low postoperative morbidity and mortality indicate that combined omental and pectoralis major flaps are a safe and effective adjunctive treatment to the antimicrobial and surgical management of select thoracic aortic vascular graft infections.

Evaluation of flap complications following pectoralis major myocutaneous flap reconstruction for oral cancers

BackgroundOral cavity cancer is among the leading cause of cancer death in India. Pectoralis major myocutaneous flaps (PMMC) are still widely used for the reconstruction of defects pertaining to head and neck region, though free flaps are considered to be gold standard. The study was aimed to identify the risk factors involved in post - operative complications of PMMC Flap for oral subsites. MethodsA total of 266 patients operated in an oncology institute over 2 years of time was evaluated based on their demographic data, pre and post-surgery details, post-operative flap morbidity were collected retrospectively from master case sheets from January 2022 to January 2024. Factors such as age, gender, stage of disease, diabetic status, and hypoprotenemia and radiation therapy were seen, analysed to find their relation in causing flap complications. ResultsTotally 266 patients were included for analysis and 16.9 % had major flap complications. On detailed analysis, it was seen that larger bipaddled flaps had higher flap complication rate, highest being wound infection. ConclusionPMMC Flap is a viable option for head and neck cancer reconstruction, specifically in cases where free microvascular flaps are not done routinely and patient presents with multiple comorbidities. Careful patient selection, pre – operative optimization, operating surgeon experience and post-operative care are contributing factors to reduce flap complications.

Versatility of the myocutaneous pectoralis major flap in oncology reconstruction: A literature review and practical application.

Pectoralis major muscle flaps are considered versatile and allow large reconstructions of anatomical defects within a single surgical procedure. Considered a "workhorse" due to these characteristics, the pectoralis major muscle is an excellent option for surgical reconstruction. Several uses of this flap are described in the literature, such as protection of the jugulocarotid system after cervical lymph node dissection, oral, cervical, breast, diaphragmatic, hypopharyngeal, pharyngeal, laryngeal, and esophageal reconstructions.

Use of Pectoralis Major Myocutaneous Flap for Marginal Mandibulectomy Defects of Oral Cavity Cancers – A 5 Year Institutional Experience

Use of Pectoralis Major Myocutaneous Flap for Marginal Mandibulectomy Defects of Oral Cavity Cancers – A 5 Year Institutional Experience

Versatility of the supraclavicular artery island flap for head and neck reconstruction.

To present our experience using the supraclavicular artery island flap (SCAIF) for head and neck reconstruction. We performed a retrospective chart review to identify patients who underwent head and neck reconstruction with SCAIF at our institution. The following data were collected: age, sex, surgical indications, flap harvest time, flap dimensions, length of hospital stay, complications, and clinical outcomes. Thirty-three patients underwent SCAIF reconstruction, of whom four underwent pectoralis major myocutaneous flap reconstruction simultaneously. Twenty flaps were used to repair pharyngeal or esophageal defects following resection for tonsillar, hypopharyngeal, laryngeal, and cervical esophageal cancers. Five flaps were used for tracheal reconstruction following resection for tracheal or thyroid gland cancer. Seven flaps were used for reconstruction of cervical skin defects or fistulas related to a previous treatment. One flap for tracheal stenosis following tracheotomy. The mean age of the patients was 60.69 ± 11.47 years. The mean flap harvest time was 32.00 ± 4.44 min. The mean flap size was 10.16 ± 3.91 × 5.78 ± 0.68 cm. The mean length of hospital stay is 24.84 ± 13.78 days. Three patients had partial necrosis of the distal portion of the flap, which resolved with anti-infection therapy and local wound care. One patient developed a fistula that was resolved with wound care and further surgical intervention. Complete flap loss or major complications were not observed. No donor site complication or compromised shoulder function was observed. The SCAIF can be successfully used to reconstruct head and neck defects with good outcomes and limited morbidity. 4.

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)

Atypical Breast Reconstruction Case: Report of the Use of Rectus Abdominis Myocutaneous Flap for Deformity Treatment in Major Pectoral Flap Donor Area

Introduction: Even with the advent of microsurgical techniques, the pedicled pectoralis major myocutaneous flap (MMF) still has considerable importance in head and neck reconstructions. However, its utilization is quite challenging especially in women. Case report: Female patient, 38 years-old sought medical attention due to a left cervical mass of progressive growth. After investigation with nuclear magnetic resonance imaging, radical cervical emptying was indicated, requiring immediate reconstruction with MMF. Subsequently, the patient returned complaining of asymmetry on the breasts and the volume of the cervical flap and a new surgical approach was performed by the plastic surgery team, where the left breast was reconstructed with a transverse rectus abdominis myocutaneous (TRAM) flap, and the MMF was thinned. Conclusion: The MMF should be used sparingly in women since resulting dysmorphisms often require surgicalre-administration for reconstruction. Therefore, it is preferable to use free flaps as a first option.

Reinstating the pedicled pectoralis major myocutaneous (PMMC) flap: a reliable solution in the era of microvascular reconstruction for floor of mouth carcinoma

Reinstating the pedicled pectoralis major myocutaneous (PMMC) flap: a reliable solution in the era of microvascular reconstruction for floor of mouth carcinoma

Ten-Year Experience of Reconstructive Techniques After Resection of Hypopharyngeal Squamous Cell Carcinoma (SCC): Changing Trend from Gastric Pull up to Free Flaps

Background: Hypo-pharyngeal squamous cell carcinoma (H-SCC) is a rare type of head and neck malignancy often necessitating extensive surgical resection and subsequent reconstruction. Objectives: This study presented a 10-year retrospective analysis of reconstructive surgeries following the resection of H-SCC. Methods: A cross-sectional study was conducted on H-SCC patients who underwent reconstructive surgery after either laryngopharyngoesophagectomy (13 cases, 42%) or pharyngolaryngectomy (18 cases, 58%). Various reconstructive techniques were employed, including gastric pull up (12 cases, 39%), pectoralis major myo-cutaneous flap (PMMCF) (11 cases, 35%), and free flaps such as jejunum (2 cases, 6%), ileocecal (2 cases, 6%), or antero-lateral thigh (ALT) (4 cases, 13%). Results: The study included 31 patients with a mean age of 56.26 ± 3.98 years, predominantly male (64%). Smoking habit was observed in 22 (71%) patients. The total complication rate was 48% including 2 (6%) cases of flap loss, 2 (6%) cases of cervical anastomosis leak, 1 (3%) case of hematoma, 2 (6%) cases of neck wound infection, 5 (16%) cases of pneumonia, and 3 (10%) cases of pleural effusion, with a mortality rate of 16%. GPU and PMMCF had total number of post operative complications of 12 and 6, respectively. ALT flap, jejunal flap and ileocecal flap had 3, 2 and 1 total complications, respectively. Severe stenosis at cervical anastomosis was found in 4 (13%) patients after GPU and not other techniques. Conclusions: Advances in microvascular anatomy knowledge have led to the evolution of reconstructive techniques. The study suggests that in upcoming years, the free flap techniques hold promise as a preferred method for hypo-pharyngeal reconstruction.

Reconstruction of Partial Hypopharyngeal Defects following Total Laryngectomy: A Systematic Review and Meta-Analysis.

Various operative techniques exist to reconstruct partial hypopharyngeal defects following total laryngectomy. The current study aimed to investigate and compare complications and functional results following commonly used reconstructive techniques. A systematic review and meta-analysis were performed using studies that investigated outcomes after the reconstruction of a partial hypopharyngeal defect. The outcomes of interest were fistulas, strictures, flap failure, swallowing function and postoperative speech. Of the 4035 studies identified, 23 were included in this review. Four common reconstructive techniques were reported, with a total of 794 patients: (1) pectoralis major myocutaneous and (2) myofascial flap, (3) anterolateral thigh free flap and (4) radial forearm free flap. Fistulas occurred significantly more often than pectoralis major myocutaneous flaps (34%, 95% CI 23-47%) compared with other flaps (p < 0.001). No significant differences in the rates of strictures or flap failure were observed. Pectoralis major myofascial flaps were non-inferior to free-flap reconstructions. Insufficient data were available to assess speech results between flap types. Pectoralis myocutaneous flaps should not be the preferred method of reconstruction for most patients, considering their significantly higher rate of fistulas. In contrast, pectoralis major myofascial flaps yield promising results compared to free-flap reconstructions, warranting further investigation.

Reconstruction after salvage total laryngectomy

Over recent decades, there has been a trend toward non-surgical or “organ preservation” therapy for advanced staged laryngeal cancers, but up to 1/3 of patients will see a lack of long-term treatment response. As a result of this paradigm shift, total laryngectomy is increasingly performed in the ‘salvage’ setting. Salvage total laryngectomy is associated with high rates of complications from impaired wound healing from prior chemotherapy and/or radiotherapy, and reconstructive techniques aim to decrease these complications. Regional and free tissue flaps are used in contemporary reconstruction of salvage laryngectomy defects. In this article, the pectoralis major myocutaneous flap and the anterolateral thigh fasciocutaneous free flap are discussed in detail. Additionally, specific techniques are described in a defect-based approach with special attention to total laryngectomy with primary closure of the mucosa, as well as defects not amenable to primary closure, such as total laryngectomy with partial or total pharyngectomy and esophagectomy. This defect-based approach allows the author to present surgical scenarios commonly encountered during salvage total laryngectomy and walk the reader through various reconstructive techniques.

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.

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.

Evaluating the Success of Pectoralis Major Myocutaneous Flap in Mandibular Reconstructions in Relation to Defect Localization

Evaluating the Success of Pectoralis Major Myocutaneous Flap in Mandibular Reconstructions in Relation to Defect Localization

Evaluation and comparison of functional and esthetic outcomes of pectoralis major myocutaneous flap with or without removal of sternocleidomastoid muscle following neck dissection in patients being operated for oral squamous cell carcinoma

India comprising the burden of oral squamous cell carcinoma which grow locally and then spreads to the cervical lymph nodes. Neck dissection is a beneficial procedure for addressing metastases in the neck arising from head and neck cancers. This surgical technique aims to remove lymph nodes on one side of the neck where cancer cells may have spread. However, this procedure can significantly impact a patient's appearance and cause distortion in the cervical area, particularly when it involves the removal of the sternocleidomastoid muscle, leading to a flattening effect in the lateral neck area. Reconstructing tissue defects following extensive surgeries in the head and neck region presents a distinct challenge for surgeons. They have the option to use either pedicled or free tissue transfer for this purpose. We compared and evaluated functional and esthetics outcomes of pectoralis major myocutaneous flap with or without removal of sternocleidomastoid muscle following neck dissection. We concluded that lack of notable distinction between the MRND type II and III groups. Both groups exhibited restricted range of motion in flexion, abduction, and external rotation. Notably, there was a significant impact on neck circumference, while shoulder functionality demonstrated gradual improvement over time. Interestingly, no substantial variances were observed between the groups in terms of drainage and wound healing. The quality of life reported by participants was generally favorable, with composite scores, social-emotional sub-scores, and average physical function aligning with acceptable standards. It's important to note that achieving a more substantial sample size is imperative to obtain results of greater significance and reliability.