Abstract
The gold standard reconstructive options for full-thickness defect of the oral cavity after resection of malignant lesions are the free flaps. But in developing nations due to resource constraints, it cannot be offered to all. Hence, pectoralis major myocutaneous (PMMC) flap as bilobed flaps is most commonly used. Bilobed flaps are technically demanding, and in females, it is more challenging due to higher complication rates especially in large breasts. There has been no major reported data evaluating outcomes of bilobed PMMC in females. This is a retrospective evaluation of outcomes of patients who underwent the bilobed PMMC flap reconstruction for full-thickness defect of the oral cavity after resection of malignant lesions from June 2018 to December 2019. Out of 80 patients, all patients ultimately had adequate tissue coverage for the defect with acceptable facial aesthetics. Functional outcomes with regards to oral continence, speech and swallowing were encouraging. Our study had 33.75% flap-related complications. Fifteen percent of patients developed varying degrees of flap loss, of which only 3.75% had total flap loss and 11.25% had partial flap loss which was managed accordingly. Our study concludes that with careful planning, raising of flap based on sound anatomic concepts and applying oncoplastic techniques, shortcomings of bilobed female PMMC can be addressed and still used as suitable alternatives for free flap for full-thickness oral cavity defects in limited resource settings.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Chaturvedi P, Pai PS, Pathak KA, Chaukar DA, Deshpande MS, Decruz AK (2004) Para-sternal approach for pectoralis major myocutaneous flap in females. J Surg Oncol 85(4):199–201
Mehta S, Agrawal J, Pradhan T, Goel A, Kumar K, Dewan AK, Veda Padma Priya S (2016) Preservation of aesthetics of breast in pectoralis major myocutaneous flap donor site in females. J Maxillofac Oral Surg. 15(2):268–271
Ahmad QG, Navadgi S, Agarwal R, Kanhere H, Shetty KP, Prasad R (2006) Bipaddle pectoralis major myocutaneous flap in reconstructing full thickness defects of cheek: a review of 47 cases. J Plast Reconstr Aesthet Surg 59(2):166–173
Bhola N, Jadhav A, Borle R, Khemka G, Kumar S, Shrivastava H (2015) Is there still a role for bilobed/bipaddled pectoralis major myocutaneous flap for single-stage immediate reconstruction of post ablative oncologic full-thickness defects of the cheek? Oral Maxillofac Surg 19(2):125–131
Sahu PK, Kumar S (2020) Bipaddle pectoralis major myocutaneous flap for single stage reconstruction of oromandibular defects. Indian J Otolaryngol Head Neck Surg 72(1):44–48
Ariyan S (1979) The pectoralis major myocutaneous flap. Plast Reconstr Surg 63(1):73–81
Ariyan S (1979) Further experiences with the pectoralis major myocutaneous flap for the immediate repair of defects from excisions of head and neck cancers. Plast Reconstr Surg 64(5):605–612
Wilson JS, Ylacoumettis AM, O’Neill T (1984) Some observations on 112 pectoralis major myocutaneous flaps. Am J Surg 147(2):273–279
Bhathena HM, Kavarana NM (1989) The folded, bipaddled pectoralis major composite flap in oral cancer reconstruction. Br J Plast Surg 42(4):441–446
Anehosur V, Dikhit PS, Nagraj N, Jayade B, Kumar N (2020 Mar 1) PMMC flap revisited and its clinical outcome in 150 patients. J Maxillofac Oral Surg 19(1):26–31
Chakrabarti S, Chakrabarti PR, Desai SM, Agrawal D, Mehta DY, Pancholi M (2015) Reconstruction in oral malignancy: factors affecting morbidity of various procedures. Ann Maxillofac Surg 5(2):191–197
Kroll SS, Goepfert H, Jones M, Guillamondegui O, Schusterman M (1990) Analysis of complications in 168 pectoralis major myocutaneous flaps used for head and neck reconstruction. Ann Plast Surg 25(2):93–97
McLean JN, Carlson GW, Losken A (2010) The pectoralis major myocutaneous flap revisited: a reliable technique for head and neck reconstruction. Ann Plast Surg 64(5):570–573
Zou H, Zhang W-F, Han Q-B, Zhao Y-F (2007) Salvage reconstruction of extensive recurrent oral cancer defects with the pectoralis major myocutaneous flap. J Oral Maxillofac Surg 65(10):1935–1939
Baek S-M, Lawson W, Biller HF (1982) An analysis of 133 pectoralis major myocutaneous flaps. Plast Reconstr Surg 69(3):460–469
Mehrhof AI Jr, Rosenstock A, Neifeld JP, Merritt WH, Theogaraj SD, Cohen IK (1983) The pectoralis major myocutaneous flap in head and neck reconstruction: analysis of complications. Am J Surg 146(4):478–482
Rikimaru H, Kiyokawa K, Inoue Y, Tai Y (2005) Three-dimensional anatomical vascular distribution in the pectoralis major myocutaneous flap. Plast Reconstr Surg 115(5):1342–1352
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Jayaprakash, D., Nandy, K., Tripathi, U. et al. Bilobed PMMC in Females: Our Challenging yet Meritorious Experience. Indian J Surg Oncol 12, 39–47 (2021). https://doi.org/10.1007/s13193-020-01223-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13193-020-01223-2