Pectoralis Major Myocutaneous Research Articles

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.

A Case Report of Corrosive Injury of Gastrointestinal Tract Managed with Pectoralis Major-Myocutaneous Patch Cover Over Pharyngo-Esophageal Anastomosis

Corrosive ingestion remains one of the most devastating problems in developing countries that cripples patient’s body, mind and soul depriving them from leading a normal social life and living with a scar on their emotions, psyche and charisma. Appropriate management in the acute phase of corrosive injury reduces tissue damage and further morbidity and mortality. The aim of this case discussion is to evoke a light of hope for those patients of corrosive injury and a guide to clinicians worldwide for further better management and sharing our experience of surgical management of a case of such corrosive injury of gastrointestinal tract.

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.

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.

Bi-Paddle Pectoralis Major Myo-Cutaneous Flap: A Step by Step Approach

We present a case of reconstruction of a large full thickness cheek defect as a result of cancer ablative surgery. This defect was reconstructed primarily by bi-paddle pectoralis major myo-cutaneous (PMMC) flap. This technique is anatomically sound, technically easy with short learning curve and also reproducible. One has to be careful, not to place more than one third of the skin paddle outside the muscle. This method of reconstruction is an alternative where microvascular free tissue transfer is contraindicated due to medical comorbidity or is not feasible due to either lack of the expertise or infrastructure. It is extremely useful in salvage in cases, in cases of the failure of microvascular flap, in selected large full thickness oral cavity lesions. However, the limitations of this method include loss of nipple area and technical difficulty in females and obese patients.

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.

Using indocyanine green angiography to achieve complete engraftment of pectoralis major myocutaneous flaps

Although the pectoralis major myocutaneous (PMMC) flap is among the useful reconstructive materials following oral cancer ablation, this flap has an unstable blood circulation that could result in partial necrosis of the skin paddle. This report describes the usefulness of indocyanine green angiography (ICGA) to achieve complete engraftment of the PMMC flap. Five patients with oral cancer underwent reconstruction with a PMMC flap after cancer ablation. During the skin paddle design and flap elevation, the blood supply to the flap was assessed by ICGA. Areas of the skin paddle that showed no ICG fluorescence were excised. Consequently, prior to transfer to the recipient site, the blood supply to all flaps was confirmed with indocyanine green visible at the edge of the skin paddle, and complete engraftment was achieved without partial necrosis. Based on the results observed, ICGA would make a useful contribution to complete engraftment of the PMMC flap.

Ipsilateral Cervicodeltopectoral Flap: A Forgotten Technique, Revival in the Era of Microvascular Reconstruction.

Oral cavity cancer is one of the most common cancers in India responsible for significant morbidity and mortality in Indian subcontinent. Majority of cases present in advanced stages which requires extensive reconstruction following tumor resection. Microvascular free flap reconstruction is now considered standard of care for reconstruction for major head and neck skin-mucosal defects but, many factors still act as hindrance like patient's comorbidities, long operating hours for microvascular reconstruction, logistic and financial issues from patient's side. In such situation it is better to have a backup plan for reconstruction of major head and neck defects using pedicled flaps. Pectoralis major myocutaneous (PMMC) flap has been the workhorse flap for head and neck reconstruction since its introduction four decades ago. But relying too much on PMMC flap for major skin-mucosal defects especially in female patients is associated with complications and risk for flap failure leading to catastrophic and significant patient morbidities. Our study involves the use of two flaps for head and neck reconstuction involving skin-mucosal defects i.e PMMC flap for mucosal defect and cervicodeltopectoral (CDP) flap for skin defect. As of now there has been no retrospective or prospective study done which has given a conclusive statement regarding use of these two flaps simultaneously for head and neck reconstruction to the best of our knowledge. In our experience from the present study, CDP flap offers an excellent alternative for extensive head and neck reconstruction and can be readily included in the surgeon's armamentarium with proper planning and meticulous handling.

Modified Technique of Pectoralis Major Myocutaneous Flap Inset for Buccal Mucosa Reconstruction.

BACKGROUNDConventional technique of flap inset in buccal mucosa reconstruction is by direct suturing of cutaneous margin of Pectoralis Major Myocutaneous (PMMC) flap to hard and soft palate mucosa and margin of floor of mouth with simple interrupted sutures. We have done a prospective study of the efficacy of anchoring the upper margin of PMMC flap to the hard palate by a modified method in reconstruction of buccal mucosa defects following tumour excision. This is to prevent disruption of suture line from the mucoperiosteum of hard palate and resultant oro-cutaneous fistula. METHODSThis hospital-based prospective study was carried out in the Department of Plastic Surgery at Bangalore, India for a period of 18 months (2015–2017). Patients (N=48) with buccal mucosa defects requiring reconstruction with PMMC flap either with conventional (n=24) or modified method (n=24) following tumour excision were included. Clinico-demographic profile of the patients including age, gender, size of defect, staging of illness, site and type of reconstruction, disruption of suture margin in the hard palate, development of oro-cutaneous fistula (OCF), day of starting oral feeds, removal of Ryle’s tube and post-operative average length of stay in the hospital were recorded. RESULTSDisruption of suture line in hard palate and Oro-cutaneous fistula were statistically significant in study group in both the variables (P-0.033, P-0.033). The median days on which patients were started with oral clear liquids and removal of Ryle’s tube were also statistically significant between study and control groups. Post-operative average length of hospital stay which is the outcome of favourable results in the study group was found to be statistically significant (P-0.021) between the groups. CONCLUSIONOverall, modified technique of anchorage of PMMC flap can be considered as a reliable technique in buccal mucosa reconstruction because of its stability, lower complication rates and shorter length of hospital stay.

SALVAGE TONGUE FLAP IN A CURIOUS CASE OF PECTORAL GAP PHENOMENON

Pectoralis Major myocutaneous (PMMC) flap is the workhorse for reconstruction in composite resection of oral cavity cases where free flaps are not feasible or not indicated. Due to the ease of harvesting it and shorter learning curve, it is done in most of the cases. But when there are any intraoperative complications like shearing of the flap or if there are any anamolies in the muscle, the surgeons have options for reconstruction like deltopectoral flap, forehead flap, nasolabial flap, latissimus dorsi flap and so on with their own advantages and disadvantages. Tongue flap is an option to be considered albeit occurrence of some restriction in the tongue movement and articulation difficulty in post operative life. Here we discuss a case of absent medial part of pectoralis major muscle for which we did a salvage tongue flap.

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 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.

Feasibility of pectoralis major myocutaneous flap for primary reconstruction of near-total glossectomy defects: A report of 2 cases

The aim of tongue cancer surgery is to restore speech and swallowing. Smaller defects have a plethora of options, including local and distant flaps to restore volume and function may not be compromised. Large tumours of the tongue require extensive resection - near total or total glossectomy, which creates large volume defects. Free flaps using microvascular reconstruction techniques are the ideal method of reconstruction in such defects. Regional flaps like pectoralis major myocutaneous (PMMC) flaps are used only as salvage flaps when the free flaps fail and they are not used as the primary method of reconstruction. The disadvantage with free flaps is that it requires a team of surgeons with microvascular expertise, which may not be feasible in low-resource settings. Hence, the workhorse flap of head–neck reconstruction, the PMMC flap, has a lot to offer in the primary reconstruction of large tongue defects. There is always a risk of lifelong dependence on feeding tubes and tracheostomy tubes following these surgeries despite free flap reconstruction. The outcomes of the reconstruction methods are validated by the absence of dependence on these tubes. We report 2 cases of near glossectomy defects reconstructed primarily by PMMC flap and the functional outcomes of speech and swallowing and the absence of dependence on tubes for feeding and breathing.

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.

Role of Pectoralis Major Myocutaneous Flap in Laryngectomy Surgery: Single Surgeon Experience.

ObjectiveTo analyze the effectiveness of the pectoralis major myocutaneous (PMMC) flap in preventing pharyngocutaneous fistula (PCF) formation for salvage total laryngectomy patients.Study designRetrospective chart review of all post-surgical laryngectomy patients for a single surgeon.MethodsInclusion criteria were adult patients 18 years and older who were diagnosed with laryngeal cancer and treated with a salvage total laryngectomy. Exclusion criteria were any laryngectomy patient treated without the PMMC flap or those with incomplete medical records.ResultsA total of 31 patient charts were identified, and 16 remained after exclusion criteria. The patient age range was 42-71 years (mean = 58.19; SD = 8.093). Greater than 85% of patients had T3 and T4 laryngeal cancers. Without PCF group were 13 patients and with PCF group were only three patients. The mean hospital days in without PCF group were 9.54 and in with PCF group were 16.33.ConclusionIn this single surgeon’s experience, PCF was prevented by using the PMMC flap in salvage total laryngectomy patients.

Unipedal pectoralis major myocutaneous flap for reconstruction of skin defects in oral cancer surgery: A prospective study of 40 cases

Background: Reconstruction following oral cancer is very important part of the treatment defining both aesthetic and functional aspects. Options available for reconstructions are regional pedicle flaps and microvascular free flaps. Pectoralis major myocutaneous (PMMC) flap is regarded as the workhorse for reconstruction in the area of oral cavity and neck. A unipedicle PMMC is a good option for reconstruction of full thickness defects after resection of tumors of oral cavity. Material and Methods: A study was undertaken on patients of soft tissue defects of head and neck region after resection of tumor of oral cavity (squamous cell carcinoma). Total 40 patients, who were treated in the department of surgical oncology were included in this study. Results: Gingivo-buccal complex was the most common site observed for oral malignancy and majority of patients were in TNM stage- III in this study. Flap survival was good in majority of cases excluding one case of total flap necrosis and 5 cases of minor edge necrosis. Conclusions: Unipedal PMMC flap is effective in reconstruction of full thickness defect of oral cavity defects even in the era of free flap reconstructions especially in developing countries. Despite few minor flap related complications PMMC flap survival rate is high and total flap necrosis rate is uncommon.

Technical Considerations and Outcome Analysis of Using Extended Bipaddle Pectoralis Major Myocutaneous Flaps for Reconstructions of Large and Complex Oral Cavity Defects: Expanding the Horizons.

The online version contains supplementary material available at 10.1007/s13193-021-01345-1.

The Effectiveness of the Bilobed Pectoralis Major Myocutaneous Flap at a Tertiary Care Hospital: A Retrospective Analytical Study.

Background:Cosmetic defects after the major orofacial disease corrections may have an effect on the overall well-being of the patient. Head-and-neck cosmetic surgeries after a major episode of oral cancer impact the functional ability of the individual in several ways. In general, two types of flap are used in reconstructive surgery: microvascular free flaps and regional pedicle flaps. In socioeconomically poor countries like India, bilobed pectoralis major myocutaneous (PMMC) flap has been seen as a mainstay in facial reconstructive surgeries.Materials and Methods:The present study was conducted on 100 individuals with oral neoplasm who underwent resective surgery had a soft-tissue defect. All the complications that arose after reconstructive surgery were noted. Simple proportions were recorded.Results:Majority of the individuals had the buccal mucosa as the common site of oral neoplasm, and the tumor nodes and metastases staging was I + II. One individual sustained total flap necrosis. Wound infection and dehiscence were the most common complications.Conclusions:PMMC is best proven for flap reconstruction in oral neoplasm cases. It is established to be effective with good acceptability and very few complications. Due to these reasons, in spite of the known advances in facial reconstructive surgeries, this technique is widely followed in developing countries.