Pectoralis Major Myocutaneous Flap in Head and Neck Reconstruction: An Experience in 100 Consecutive Cases

Overview

Journal Natl J Maxillofac Surg

Date 2015 Dec 16

PMID 26668451

Citations 19

Authors

Mayank Tripathi

Sanjeev Parshad

Rajender Kumar Karwasra

Virender Singh

Affiliations

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Abstract

Background: The pectoralis major myocutaneous (PMMC) flap has been used as a versatile and reliable flap since its first description by Ariyan in 1979. In India head and neck cancer patients usually present in the advanced stage making PMMC flap a viable option for reconstruction. Although free flap using microvascular technique is the standard of care, its use is limited by the availability of expertise and resources in developing world. The aim of this study is to identify the outcomes associated with PMMC flap reconstruction.

Patients And Methods: After ethical approval we retrospectively analyzed 100 PMMC flap at a tertiary care hospital from 2006 to 2013. A total of 137 PMMC flap reconstructions were performed out of which follow-up data of 100 cases were available in our record.

Results: A total of 100 patients were reviewed of these 86% were of oral cavity and oropharyngeal lesions, 8% were of hypopharyngeal, 3% were of laryngeal malignancies and 3 cases were of salivary gland tumor. Most tumors (83%) were advanced (T3 or T4 lesion). 95 PMMC flap reconstruction were done as a primary procedure, and 5 were salvage procedure. PMMC flap was used to cover mucosal defect in 84 patients, skin defects in 10 patient and both in 6 patients. Overall flap related complications were 40% with a major complication in 10% and minor complications in 30%. No total flap loss occurred in any patient, major flap occurred in 6% and minor flap loss in 12%. In minor flap loss patients, necrotic changes were mostly limited to skin. Orocutaneous and pharyngocutaneous fistula developed in 12 patients. 10% patients required re-surgery after developing various flap related complications Pleural empyema developed in 3 patients. Other minor complications such as neck skin dehiscence and intra-oral flap dehiscence developed in 26 patients.

Conclusion: PMMC flap is a versatile flap with an excellent reach to face oral cavity and neck region. With limited expertise and resources, it is still a workhorse flap in head and neck reconstruction.

Citing Articles

Assessing the Efficacy and Reliability of Pedicled Myocutaneous Single-Staged Flaps in Oral Cancer Ablation Surgery: A Prospective Interventional Study.

P Somani S, N V, Subramaniam A, Chandran S Cureus. 2025; 17(1):e77484.

PMID: 39958091 PMC: 11827873. DOI: 10.7759/cureus.77484.

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

Timarcioglu G, Sen O, Gedik E, Bahran U, Karacakurtoglu M, Candirli C J Maxillofac Oral Surg. 2024; 23(6):1411-1418.

PMID: 39618460 PMC: 11607255. DOI: 10.1007/s12663-024-02126-3.

Comparing the Efficacy of 3% NaCl With Pressure Dressing and Oral Glycopyrrolate With Pressure Dressing in the Treatment of Parotid Sialocele in Postoperative Oral Squamous Cell Carcinoma Patients: Study Protocol of a Randomized Controlled Trial.

Phalak J, Shukla D, Bhola N Cureus. 2024; 16(7):e65237.

PMID: 39184630 PMC: 11343336. DOI: 10.7759/cureus.65237.

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.

Chaturvedi G, Kushwaha A, Jha R, Suhag K Cureus. 2024; 16(4):e58022.

PMID: 38738011 PMC: 11087882. DOI: 10.7759/cureus.58022.

Folded Pectoralis Major Myocutaneous Flap for Reconstruction of Complex Oral Commissural Defects: A Retrospective Case Series and Technical Report.

Mitra S, Panda S, Singh C, Mani S, Thakar A Indian J Otolaryngol Head Neck Surg. 2024; 76(1):1251-1254.

PMID: 38440572 PMC: 10908651. DOI: 10.1007/s12070-023-04251-w.

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