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Pectoralis Major Myocutaneous Flap for Head and Neck Defects in the Era of Free Flaps: Harvesting Technique and Indications

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ABSTRACT

The role of the pectoralis major myocutaneous flap (PMMF) in head and neck reconstruction is challenged recently due to its natural drawbacks and the popularity of free flaps. This study was designed to evaluate the indications and reliability of using a PMMF in the current free flap era based on a single center experience. The PMMF was harvested as a pedicle-skeletonized flap, with its skin paddle caudally and medially to the areola, including the third intercostal perforator, preserving the upper one third of the pectoralis major muscle. The harvested flap was passed via a submuscular tunnel over the clavicle. One hundred eighteen PMMFs were used in 114 patients, of which 76 were high-risk candidates for a free flap; 8 patients underwent total glossectomy, and 30 underwent salvage or emergency reconstruction. Major complications occurred in 4 patients and minor complications developed in 10. Tracheal extubation was possible in all cases, while oral intake was possible in all but 1 case. These techniques used in harvesting a PMMF significantly overcome its natural pitfalls. PMMFs can safely be used in head and neck cancer patients who need salvage reconstruction, who are high risk for free flaps, and who need large volume soft-tissue flaps.

No MeSH data available.


Six months after operation, the cosmetic and functional result was acceptable.
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f8: Six months after operation, the cosmetic and functional result was acceptable.

Mentions: All patients were followed up every 3 months in the outpatient department. Donor-site-related morbidity was assessed and recorded by a trained outpatient nurse 6–12 months after surgery. We developed a 3-item questionnaire based on the Shoulder Pain and Disability Index46 and Lowery Scaling System47. To simplify the functional evaluation, the participants were asked to rate the severity of perceived daily shoulder pain and disability as none, mild, moderate, and severe; and the perceived chest wall cosmetic outcome was rated as excellent, good, fair, and poor (Fig. 8).


Pectoralis Major Myocutaneous Flap for Head and Neck Defects in the Era of Free Flaps: Harvesting Technique and Indications
Six months after operation, the cosmetic and functional result was acceptable.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5384233&req=5

f8: Six months after operation, the cosmetic and functional result was acceptable.
Mentions: All patients were followed up every 3 months in the outpatient department. Donor-site-related morbidity was assessed and recorded by a trained outpatient nurse 6–12 months after surgery. We developed a 3-item questionnaire based on the Shoulder Pain and Disability Index46 and Lowery Scaling System47. To simplify the functional evaluation, the participants were asked to rate the severity of perceived daily shoulder pain and disability as none, mild, moderate, and severe; and the perceived chest wall cosmetic outcome was rated as excellent, good, fair, and poor (Fig. 8).

View Article: PubMed Central - PubMed

ABSTRACT

The role of the pectoralis major myocutaneous flap (PMMF) in head and neck reconstruction is challenged recently due to its natural drawbacks and the popularity of free flaps. This study was designed to evaluate the indications and reliability of using a PMMF in the current free flap era based on a single center experience. The PMMF was harvested as a pedicle-skeletonized flap, with its skin paddle caudally and medially to the areola, including the third intercostal perforator, preserving the upper one third of the pectoralis major muscle. The harvested flap was passed via a submuscular tunnel over the clavicle. One hundred eighteen PMMFs were used in 114 patients, of which 76 were high-risk candidates for a free flap; 8 patients underwent total glossectomy, and 30 underwent salvage or emergency reconstruction. Major complications occurred in 4 patients and minor complications developed in 10. Tracheal extubation was possible in all cases, while oral intake was possible in all but 1 case. These techniques used in harvesting a PMMF significantly overcome its natural pitfalls. PMMFs can safely be used in head and neck cancer patients who need salvage reconstruction, who are high risk for free flaps, and who need large volume soft-tissue flaps.

No MeSH data available.