Pectoralis Major Myocutaneous Flap Research Articles

Stoma recurrence after laryngectomy: Guiding principles of “anterior mediastinal tracheostomy"

BackgroundExtensive radical resections of cervicothoracic malignancies or stomal recurrences after total laryngectomy are technically demanding involving the division of the thoracic trachea, resulting in an “anterior mediastinal tracheostomy”.The case in point is described in a patient who presented with a bleeding, partially obstructed stomal recurrence following salvage laryngectomy. We did a wide excision under frozen section control of the involved stoma and retrosternal trachea with an access manubrectomy, leaving 5 cm of the remnant trachea for end stomal fashioning. A pectoralis major myocutaneous flap was used for filling the dead space between the trachea and brachiocephalic artery and the remnant skin. ConclusionMalignant cervicothoracic tumours can pose a significant threat to a patient's survival by compromising their airway centrally with or without the ability to swallow. In certain carefully selected cases, extensive resection with anterior mediastinal tracheostomy may be the only viable solution.

Management of head & neck sarcomas in adults: A retrospective study

The research purpose is to review the surgical approach and evaluate the results in adult patients with head and neck sarcomas.The histopathology varied, including two leiomyosarcomas, six malignant fibrous histiocytomas, two malignant peripheral nerve sheath tumors, four dermatofibrosarcomas protuberans, three osteosarcomas, two angiosarcomas, one liposarcoma, one Ewing sarcoma, one synovial sarcoma, two unclassified/non-differentiated sarcomas and one solitary fibrous tumor. Surgical resection included maxillectomy, mandibulectomy, craniectomy, parotidectomy, scalp resection, face skin resection and laminectomy. The reconstruction was performed with one rectus abdominis flap, four radial forearm flaps, two latissimus dorsi flaps, two vascularized fibula flaps, two pectoralis major myocutaneous flaps, two trapezius flaps, two temporalis flaps, seven scalp flaps and two nasolabial flaps.The total patient number was 24. The hospitalization was uncomplicated, followed by postoperative radiotherapy in the majority of cases. In a mean 15-year follow-up period, 11 patients are still alive and disease-free. There were four recurrences treated with palliative radiotherapy.The surgical approach for head and neck sarcomas, including the achievement of a functionally acceptable result by organ sparing techniques, remains challenging. Wide resection combined with the appropriate reconstruction, particularly with microsurgical techniques, and followed by adjuvant radiotherapy or chemotherapy offer improved prognosis and quality of life.

Association of pectoralis major myocutaneous flap and inverted T mammoplasty for reconstruction of extensive chest wall defect: case report

Association of pectoralis major myocutaneous flap and inverted T mammoplasty for reconstruction of extensive chest wall defect: case report

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.

Treatment regimen for deep sternal wound infections after cardiac surgical interventions in an interdisciplinary approach

The aim of this article is to present the importance of astructured and situation-adapted approach based on the diagnostic and therapeutic strategy in the interdisciplinary treatment of 54patients with deep sternal wound infections (DSWI) after cardiac surgical interventions and the results achieved. The patients were 41men and 13women with an average age of 65.1years, who developed aDSWI after acardiac surgical intervention during the period 2003-2016. The treatment strategy included athorough debridement including the removal of indwelling foreign material, the reconstruction with astable re-osteosynthesis after overcoming the infection and if necessary, situation-related surgical flaps for adefect coverage with agood blood supply and mandatory avoidance of dead spaces. Atotal of 146operations were necessary (average 2.7operations/patient, range 1-7operations). In 24.1 % of the cases a one-stage approach could be carried out. In 41 patients negative pressure wound therapy (NPWT) with programmed sponge changing was used for wound conditioning (mean 5changes, standard deviation, SD± 5.6 changes over 22days, SD± 23.9days, change interval every 3-4days in 40.7% of the cases). In 33patients abilateral myocutaneous pectoralis major flap was used, in 4patients avertical rectus abdominis myocutaneous (VRAM) flap and in 7patients both were carried out. Atotal of 43osteosynthesis procedures were carried out on the sternum with fixed-angle titanium plates. Of the patients 7died during intensive care unit treatment (total mortality 13 %, n = 5, 9.3 % ≤ 30days) or in the later course. Of the patients 47 (87.1 %) could be discharged with acleansed infection. In 2patients the implant was removed after 2years due to loosening.

Abstract 13814: Combined Omental and Bilateral Pectoralis Major Flaps for Treatment of Thoracic Aortic Graft Infections

Introduction: Aortic graft infections have historically been managed through graft removal and replacement. However, coverage with vascularized tissue flaps may provide an effective alternative, particularly in patients who are not able to undergo extended extra-anatomic bypass procedures. Hypothesis: Here we describe our experience treating thoracic aortic graft infections with combined omental and bilateral pectoralis major myocutaneous (PMM) advancement flaps. Methods: All patients undergoing sternal wound treatment with PMM flaps by the senior author (JAA) at a high-volume cardiac surgery center from 1996-2023 were reviewed. Patients with evidence of aortic graft infection were included. Results: Complete data were available for 598 patients, 11 of whom had combined PMM and omental flaps mobilized for aortic graft infections. ASA score was >4 in 9/11 (81.9%). At the index cardiac surgery, 11/11 (100%) underwent aortic root repair/replacement, and 9/11 (81.9%) also underwent aortic valve repair/replacement. Indications in this group for flap surgery included culture-positive infection (8/11; 72.7%), dehiscence (5/11; 45.5%), drainage (7/11; 63.6%), and inability to close the sternotomy incision due to hemodynamic instability (5/11; 45.5%). During chest exploration, 7/11 (63.6%) underwent complete removal of the infected graft, compared to 4/11 (36.4%) who underwent graft-preserving washout and debridement. Immediate flap closure was performed in 4/11 (36.4%). Intraoperative mediastinal cultures were positive in 3/11 (27.3%). Post-operative complications included dehiscence (1/11; 9.1%), seroma (2/11; 18.2%), hematoma (1/11, 9.1%), abdominal hernia (1/11; 9.1%), and recurrent infection (1/11; 9.1%). One (9.1%) patient died within 30 days of sternal reconstruction from mitral valve failure and a tachyarrhythmia. None have undergone reoperation for flap-related complications, while one patient underwent elective resection due to aesthetic complaints. Conclusions: Low postoperative morbidity and mortality indicate that combined omental and pectoralis major flaps are a safe and effective treatment for aortic graft infections.

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

Hara Hara Mahadev (HHM) maneuver: Simple Yet Effective Way of Post-Operative Physiotherapy after Reconstruction with Pectoralis Major Myo-cutaneous Flap in Oral Cancer Defects

Hara Hara Mahadev (HHM) maneuver: Simple Yet Effective Way of Post-Operative Physiotherapy after Reconstruction with Pectoralis Major Myo-cutaneous Flap in Oral Cancer Defects

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.

Repair of Surgical Defect by Pectoralis Major Flap Versus Free Radial Forearm Flap in Buccal Carcinoma: Assessment of Quality of Life

Background: Soft tissue reconstruction of the oral cavity is the most critical factor in achieving a successful functional result. Malignant lesions occurring in the buccal area are usually treated with primary surgical and/or radiotherapy of the head and neck region. Depending on the location and size of the buccal tumor, radical surgical treatment often affects all oral function such as speech, swallowing, chewing, oral rehabilitation, nutrition and appearance. To maximize postoperative function, flap repair is currently the preferred method for reconstruction of buccal defects after major surgery. Among the flaps most commonly used are pedicle pectoralis major myocutaneous flap and the free radial forearm fasciocutaneous flap. The choice of the best reconstructive option is still controversial. Objective: To find out the quality of life after repair of surgical defect by pectoralis major flap versus free radial forearm flap in buccal carcinoma. Methods: This prospective study was conducted in the department Otolaryngology- Head & Neck Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka from September 2017 to August 2019. A total number of 44 cases of buccal carcinoma patient who had the inclusion criteria were enrolled as a study sample. These subjects were selected from the Department of Otolaryngology-Head & Neck Surgery, Department of Oral & Maxillofacial Surgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, National Institute of ENT, Tejgaon, Dhaka. Comparison of nominal or ordinal variables between patients who have undergone surgery with either the RFFF or PMMF were analyzed using a chi-square test. The UW-QOL scores were compared for each domain using the nonparametric Mann-Whitney test. P-value < .05 was accepted as the level of significance. Results: In this study 40 out of 44 patients were completed UW-QOL questionnaires. The median age was 52 (range 40-65years), the male-female ratio was 1.44:1. All were habituated in either smoking or betel leaf/ nut or alcohol. Most of them were illiterate to the primary level of education and suffering from stage- iii tumor. All these variables were statistically insignificant except gender. Patients reconstructed with RFFF felt better in shoulder domains than PMMF but felt worse appearance domains and these were statistically significant in both 3 months and 6 months postoperatively. Conclusion: The study result had shown that reconstruction of the defect after buccal cancer resection using either RFFF or PMMF significantly influences patient’s quality of life. This study will provide valuable information for surgeons who will decide reconstruction modalities for buccal cancer and also will help the patients getting a better outcome. Bangladesh J Otorhinolaryngol 2023; 29(1): 32-38

Bipaddle Pectoralis Major Myocutaneous Flap (PMMC) for Complex Composite Oral Cavity Defects: An Experience of a Tertiary Cancer Centre.

Although microvascular free flaps are considered the first choice in head and neck cancer defect reconstruction, their use is limited in developing regions by availability of resources and the expertise .The Bipaddle pectoralis major myocutaneous flap (PMMC flap) is a commonly used flap in head and neck cancer reconstruction, but in literature flap is associated with high incidence of drawbacks including donor site morbidity and added bulk of the flap reducing cosmetics and function. The purpose of the study is to evaluate the Bipaddle PMMC flap reliability, operative technique and outcome in reconstructive head and neck cancer surgery in the era of microvascular free flaps. Its a prospective study in which the records of 50 patients treated with Bippadle PMMC flap reconstruction between January 2022 to July 2022 were systematically collected and reviewed. Data of recipient site, serum albumin, history of adjuvant, recurrence, defect dimension, type of donor site closure, length of hospital stay, postoperative complications and outcomes were analysed. There were 45 males and 5 females with a mean age of 41 years (31-60). Bipaddle PMMC flap reconstruction was done in all patients of advanced squamous cell carcinoma of oral cavity. There were two males with complete necrosis of flap salvaged with latissimus dorsi flap and forehead flap. Minor infections were noted in two female and one male patient, managed conservatively and recovered well with acceptable final outcome. The Bipaddle PMMC flap is reliable for large defects in head and neck reconstructive surgery, particularly when a bulky flap is required to reconstruct composite defects where the lesion is involving the skin. Placing the flap horizontally with inclusion of nipple and areola in most of the patients increased the reach and size of available flap.

Distal positioning of the skin paddle of pectoralis major myocutaneous flap in head and neck reconstruction.

To assess outcomes of pectoralis major myocutaneous flap (PMF) wherein the skin paddle (SP) was positioned with its distal portion extending beyond the lower border of pectoralis major by ≥2 cm (PMF-d). Consecutive head and neck reconstructions with PMF-d (n = 110). SP dimensions l2 (distal extent below the lower border of pectoralis major), l1 (proximal extent above lower border of pectoralis major), and b (breadth) were recorded. Endpoints were SP necrosis, recipient dehiscence, early fistula, and persistent fistula. Median values of l2 , l1 , and b were 3.0, 6.0, and 6.0 cm, respectively. When l2 = 2.0-3.0 cm, SP necrosis occurred in only one (1%) subject (with obesity). When l2 was ≥3.5 cm, necrosis occurred in four (16%) subjects, three of whom also had l1 /l2 < 2.0 (proximal SP < 67% of entire SP). Statistically, increased l2 was the only risk factor for necrosis (p = 0.001). Overall, incidence of recipient dehiscence, early fistula, and persistent fistula were 32 (29%), 20 (20%), and 3 (3%), respectively. Persistent fistula occurred only in the setting of SP necrosis and/or re-irradiation. Careful patient selection, adequate proximal SP, and l2 = 2.0-3.0 cm is associated with a negligible risk of necrosis. The enhanced reach and laxity and additional skin surface area and soft tissue volume conferred with PMF-d facilitate recipient wound healing.

Letter to Editor: Head and Neck Reconstruction With 2-Stage External Pectoralis Major Myocutaneous Flap Transfer.

Letter to Editor: Head and Neck Reconstruction With 2-Stage External Pectoralis Major Myocutaneous Flap Transfer.

The harvestion and application experience of free multi-lobed anterior thigh flap

Objective: To introduce the technique and clinical application of free lobed anteromedial thigh perforator pedicle flap. Methods: From September 2015 to September 2021, 72 patients with perforating buccal and oral cancer defects were treated at the Oncology Plastic Surgery Department of Hunan Cancer Hospital. There were 61 males and 11 females, with an average age of 36.7 years (31-56 years). According to Union for International Cancer Control (UICC) TNM staging, there were 20 cases of T3N1M0, 13 cases of T3N2M0, 24 cases of T4N0M0, and 15 cases of T4N1M0. All defects were planned to be repaired with free lobed anteromedial perforator flaps. When there was only one set of vascular pedicle, the perforating vascular pedicle artery was anastomosed with the superior thyroid artery, and the accompanying vein was anastomosed with the superior thyroid vein by end-to-end. Results: The areas of soft tissue defects after radical resection of oral and buccal cancers in 72 patients were between 5.0 cm × 4.0 cm and 11.0 cm×7.0 cm; the areas of the first anterior femoral skin islands were between 5.0 cm × 4.0 cm and 13.0 cm×7.0 cm; the areas of the second anterior femoral skin islands were between 5.0 cm × 3.0 cm and 10.0 cm × 7.0 cm; and all flap donor sites were directly closed. In 35 cases, the vascular pedicle was accompanied by a lateral femoral muscle flap for filling the gap defect at the base of the mouth. The average length of the vascular pedicles of the flaps was 7.2 cm (range: 6.8-8.2 cm). The average diameter of the vascular pedicle arteries was 1.6 mm (range: 1.4-2.2 mm). The blood flow reconstruction of flap was completed by anastomosing one accompanying vein. The average diameter of the accompanying veins was 2.1 mm (range: 1.6-2.8 mm). Postoperative hematoma occurred in 3 patients, with one having vascular crisis. After emergency exploration, 2 of them were successfully saved, and the other one had complete necrosis of skin flap, which was repaired by pedicled pectoralis major skin flap transplantation. With following up of 12-38 months, the appearances of the flaps were satisfactory without significant swelling. The mouth opening and language function were satisfactory in all cases, and only linear scars were left in the donor sites, with no significant impact on thigh functions. Five patients with local recurrence of tumor were treated with second radical resection and repair with pedicled pectoralis major myocutaneous flap. Six patients developed cervical lymph node metastasis (4 on the same side and 2 on the opposite side) and underwent neck dissection again. Conclusion: The anatomical basis of the branches of the anteromedial femoral perforating branches in the anterolateral region of the thigh can be helpful to prepare the anterolateral femoral lobed flap, which is suitable for repairing the perforating defects after the radical operation of oral and buccal cancers.

Submammary Approach for Harvesting Pectoralis Major Myocutaneous Flap in Females with Oral Cavity Cancers: Report of Technique and Our Experience.

Oral squamous cell carcinoma is one of the most common types of cancers affecting both male and female population worldwide. Currently gold standard for reconstruction of oral cavity defects is free flap reconstruction. However, in developing countries due to large case load, infrastructural and resource constraints, Pectoralis major myocutaneous flap is still widely being used. Harvesting PMMC flap in females is challenging due to thick fat and breast tissue affecting its reliability and also increased donor site morbidity. This article aims at highlighting our experience with harvesting PMMC flap in female patients by submammary approach and its outcomes. A total of 23 female patients who underwent wide local excision of oral cavity cancers and reconstruction with PMMC flap were included. Data was analysed as mean, median, mode, percentages and statistical averages. Majority of patients belonged to 40-60years of age group (60.86%). Buccal mucosa was the most common site of primary lesion in 16 patients (69.56%). Out of the 23 patients who underwent PMMC flap reconstruction, recipient site complications were seen in 4 patients including total flap loss in 2 patients (8.69%), minor complications, e.g. infection in 2 patients (8.69%). Donor site morbidity in the form of axillary seroma was seen in only 1 patient (4.34%). In our experience, PMMC flap is still a viable option for reconstruction especially in resource constraint settings. Submammary approach to PMMC flap harvest is a safe technique as it is associated with minimum recipient site complications whilst preserving donor site anatomy and thereby reducing donor site morbidities to minimum.

Prosthetic Management of Flap-Related Complications Following Glossectomy in Locally Advanced Tongue Cancer.

Total glossectomy defects resulting from postoncologic resection are commonly reconstructed with locoregional or free flaps. However, effectively managing complications that may arise after reconstruction can be a significant challenge. We present a unique case series describing prosthetic management of flap-related complications following glossectomy in patients treated for locally advanced tongue cancer. Three patients underwent total glossectomy, neck dissection, reconstruction using free flap, and tracheostomy. Two patients developed an intraoral fistula located in the anterior region of the floor of the mouth. The third patient developed a flap failure requiring a second procedure using a pectoralis major myocutaneous flap for correction of the orocutaneous fistula that ultimately did not heal. Mandibular obturator prostheses lined with a soft liner were fabricated for all the patients, which helped reduce salivary incontinence and improve swallowing and speech. This case series highlights that a collaborative interdisciplinary team approach is crucial for optimizing postoperative function and outcomes when managing complications from reconstructive procedures.

Beyond Traditional Approaches: A Pilot Study Exploring the Role of Injection Mitomycin C on the Surgical Resection Bed in Oral Cancer Treatment.

Background Oral cavity cancer ranks sixth among all cancers worldwide. India has the most oral cancer cases and accounts for one-third of the global oral cancer burden. Oral cavity cancer is known to be associated with an elevated likelihood of locoregional recurrences, which account for the bulk of post-surgery and radiotherapy treatment failures. Mitomycin C (MMC) is an antineoplastic and antibiotic agent that is administered topically rather than intravenously to treat bladder and intraperitoneal tumors to avoid recurrences. This study aimed to investigate the use of injection MMC as a local application on surgical resection beds for patients undergoing surgery for oral cancer and to assess its efficacy in preventing regional recurrences. Methodology In this prospective, interventional, pilot study, patients were assigned randomly to two groups using simple randomization. Group A involved the application of two gauze pieces soaked with MMC injection. Group B involved the application of two gauze pieces soaked with a 10% betadine solution. During the pectoralis major myocutaneous flap harvest procedure for reconstruction, two gauze pieces soaked with either injection MMC solution (20 mg MMC in 20 mL of 0.9% normal saline) or 10% betadine solution were placed on the surgical resection bed for a 45-minute contact period. Patients were evaluated daily in the postoperative period for local complications. Regular follow-up visits were scheduled for 15 months of follow-up. Results After exclusions at various phases, the final analysis included 50 patients in Group A and 50 patients in Group B. Minor complications, specifically blackening of the skin flap in the neck resulting in surgical site infections, were observed in 16% (eight patients) of the MMC group and in 6% (three patients) of the betadine group (p = 0.1997) patients. In the MMC group, two (4%)patients experienced locoregional recurrences at three months, four (8%) patients at six months, six (12%) patients at nine months, eight (16%) patients at 12 months, and 10 (20%)patients at 15 months of follow-up. In contrast, locoregional recurrences occurred in two (4%) patients in the betadine group at three months, six (12%)patients at six months, nine (18%) patients at nine months, 12 (24%) patients at 12 months, and 15 (30%) patients at 15 months. Although the difference in locoregional recurrences between the two groups was not statistically significant, there was a trend of decreasing locoregional recurrences in the MMC group relative to the betadine group as the duration of follow-up increased. In the subgroup analysis of patients with pathological extranodal extension (ENE), only 10 of 18 patients with ENE in Group A (55.55%) experienced a recurrence, whereas all 12 patients with ENE in Group B (100%) experienced a recurrence within the same time frame. This difference in locoregional recurrence rates between the two groups was statistically significant, with a p-value of 0.0100. Conclusions Our study demonstrated that the local administration of MMC on surgical resection beds may lower the risk of locoregional recurrences in patients with oral cancer, especially those with ENE. These findings contribute to the ongoing efforts to enhance treatment strategies and patient outcomes for this challenging malignancy.

Pedicled thoracoacromial artery compound flaps for circumferential hypopharyngeal reconstruction.

Total laryngeal and hypopharyngeal resection remained to be the mainly treatment option for advanced hypopharyngeal cancer, which resulted in complicated reconstructive challenge for circumferential hypopharyngeal defect. The pedicled thoracoacromial artery compound flaps included Thoracoacromial artery perforator (TAAP) flap and pectoralis major myocutaneous (PMMC) flap. This study is to evaluate the clinical application of the pedicled thoracoacromial artery compound flaps for circumferential hypopharyngeal reconstruction. From May 2021 to April 2022, four hypopharyngeal cancer patients with circumferential hypopharyngeal defects were reconstructed by the pedicled thoracoacromial artery compound flaps. All patients were males. Patient age ranged from 35 to 62years (average, 50years). The Shoulder function were evaluated by SPADI. The average follow-up was 10.25months (range from 4 to 18months). All of the pedicled thoracoacromial artery compound flaps in our study survived. The defect length between tongue base and cervical esophagus ranged from 8 to 10cm after total laryngeal and hypopharyngeal resection. The TAAP flap size ranged from 6 × 7cm to 7 × 10cm, and the PMMC flap size ranged from 6 × 7cm to 9 × 12cm. The pedicle length of TAAP and PMMC flaps varied, respectively, from 5 to 8cm (mean 6.5cm) and 7cm to 11cm (mean 8.75cm). The mean time of TAAP and PMMC flaps harvest was, respectively, 82min and 39min. All patients were able to resume soft diet in the fourth week of postoperation, but one patient was operated by gastrostomy in the second month of postoperation because of pharyngeal cavity stenosis, and the patient successfully resumed oral soft diet by endoscopic balloon dilation after postoperation radiotherapy. All patients have resumed oral feeding at last. There were mild dysfunction for our patients according to SPADI during the mid-long follow-up. The pedicled thoracoacromial artery compound flaps have stable blood supply and provide adequate muscle coverage for greater protection during radiotherapy, and the microsurgical skills have no requirement. Therefore, the compound flaps provide a good choice for the reconstruction of circumferential hypopharyngeal defect, especially in the aged or patients with comorbidities who are not able to tolerate prolonged surgery.

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.

The Outcome of Treatment in Second Branchial Cleft Anomalies: A Case Series.

Background Branchial-cleft anomalies are second only to thyroglossal duct anomalies among congenital malformations of the neck, and second branchial-cleft anomalies are the most common. These include branchial cysts, branchial sinuses, and branchial fistulas. Clinical symptoms include neck swelling and a discharging sinus or fistula opening. In a small number of cases, they can lead to major complications like abscesses or malignant changes. Surgical resection is the treatment of choice. Various approaches to resection and sclerotherapy have been tried. In this study, we present our treatment outcome with branchial cleft anomalies at a ruraltertiary medical care hospital. Objectives To document the various presentations, clinical features, and outcomes of treatment with second branchial cleft anomalies. Methods This retrospective observational study included 16 patients operated on for second branchial-cleft anomalies. A detailed medical history was elicited, and an accurate clinical examination was done. A contrast-enhanced computed tomography (CECT) scan was done in all cases. A few cases required a fistulogram. The cysts, sinuses, or fistulas were resected en bloc by a single neck crease incision. Primary closure was done in all cases. A recurrence or pharyngocutaneous fistula required axial flap reconstruction. The complications and recurrences were documented. Result There were six children and 10 adults in our study. Seven cysts, five sinuses, and four fistulas were present, of which four were iatrogenic. In seven patients, imaging could not show the entire tract. There were four fistulas from the oropharynx to a cutaneous opening in the neck. A complete resection was done for all. Two pharyngocutaneous fistulas were treated with a pectoralis major myocutaneous (PMMC) flap. Three patients had wound dehiscence postoperatively. None of the patients had neurological or vascular injuries. Conclusion Second branchial cleft anomalies can be completely excised by a single neck crease incision. Meticulous surgery results in a low recurrence or complication rate.Following complete excision, in type IVanomalies, a purse-string suture at the pharyngeal opening ensures good closure and no recurrences.