Pectoralis myocutaneous flap remains the workhorse for the reconstruction of large defects in the head and neck region despite free flaps gaining popularity; because of its drawbacks such as long operating hours, high cost and special skill techniques, it is not used in most of the institutions. Even in our institution, free tissue transfers are carried out on a regular basis, but there is a definite scope and role for PMMC flap in reconstruction. We present our experience with pectoralis major myocutaneous flap in terms of postoperative complications, donor site morbidity, flap survival and long-term healing of the flap.
Materials and methods
In this study, 150 patients who underwent pectoralis myocutaneous flap reconstruction from 2008 to 2016 were analysed for postoperative complications like donor site morbidity, flap survival and long-term healing of the flap.
On analysis of our data, it was found that the most common complication was wound dehiscence, which was seen in 25 patients(16%), followed by orocutaneous fistula in 15 (10%), wound infection and partial skin margin necrosis, which was seen in a maximum of 12 each(8%), hematoma in 5 (3%), and donor site wound dehiscence in 5 (3%), and there was no case of total flap failure or carotid blowout.
We conclude that PMMC flap along with its modifications is the most cost-effective and associated with least complications.
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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. https://doi.org/10.1097/00006534-197911000-00002
Sharma S, Murty P, Hazarika P, Nayak D, Sharma S (1998) The indications and complications of pectoralis major myocutaneous flap reconstruction in head and neck surgery-our experience. Indian J Otolaryngol Head Neck Surg 50(4):362–367. https://doi.org/10.1007/bf03000688
Pinto F, Malena C, Vanni C, Capelli F, Matos L, Kanda J (2010) Pectoralis major myocutaneous flaps for head and neck reconstruction: factors influencing occurrences of complications and the final outcome. Sao Paulo Med J 128(6):336–341. https://doi.org/10.1590/s1516-31802010000600005
Tripathi M, Parshad S, Karwasra R, Singh V (2015) Pectoralis major myocutaneous flap in head and neck reconstruction: an experience in 100 consecutive cases. Natl J Maxillofac Surg 6(1):37. https://doi.org/10.4103/0975-5950.168225
Schneider D, Wu V, Wax M (2011) Indications for pedicled pectoralis major flap in a free tissue transfer practice. Head Neck 34(8):1106–1110. https://doi.org/10.1002/hed.21868
Saito A, Minakawa H, Saito N, Nagahashi T (2012) Indications and outcomes for pedicled pectoralis major myocutaneous flaps at a primary microvascular head and neck reconstructive center. Mod Plast Surg 02(04):103–107. https://doi.org/10.4236/mps.2012.24025
El Marakby H (2006) The reliability of pectoralis major myocutaneous flap in head and neck reconstruction. J Egypt Natl Canc Inst 18(1):41–50
Shah J, Haribhakti V, Loree T, Sutaria P (1990) Complications of pectoralis major myocutaneous flap in head and neck reconstruction. Am J Surg 160:352–355. https://doi.org/10.1016/s0002-9610(05)80541-0
Baek S, Lawson W, Biller H (1982) An analysis of 133 pectoralis major myocutaneous flaps. Plast Reconstr Surg 69(3):460–467. https://doi.org/10.1097/00006534-198203000-00010
Nagarjuna M, Patil B, Nagraj N, Gopalkrishnan K (2013) Use of superiorly based vertical rectus abdominis myocutaneous flap for the correction of costal osteomyelitis at the pectoralis major myocutaneous flap donor site. J Oral Maxillofac Surg 71(2):e132–e136. https://doi.org/10.1016/j.joms.2012.10.011
Bhola N, Jadhav A, Borle R, Khemka G, Kumar S, Shrivastava H (2014) 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. https://doi.org/10.1007/s10006-014-0458-1
Deo S, Purkayastha J, Diganta DL, Kar M, Srinivas G, Asthana S, Shridhar D, Shukla NK (2003) Reconstruction of complex oral defects using bi-paddle pectoralis major flap-technical modifications and outcome in 54 cancer patients. Indian J Otolaryngol Head Neck Surg 55(1):5–9. https://doi.org/10.1007/bf02968744
Chaturvedi P, Joshi P (2013) Partial Bipaddling of PMMC flap in full thickness cheek defects involving lip commissure: a novel technique. Int J Head Neck Surg 4:113–114. https://doi.org/10.5005/jp-journals-10001-1155
Wei W, Lam K, Lau W (1989) Fate of skin element of pectoralis major flap in intraoral reconstruction. Arch Otolaryngol Head Neck Surg 115(3):360–363. https://doi.org/10.1001/archotol.1989.01860270102022
Chen Y, Wang C, Wang C, Jiang R, Lin J, Liu S (2014) Carotid blowout in patients with head and neck cancer: associated factors and treatment outcomes. Head Neck 37(2):265–272. https://doi.org/10.1002/hed.23590
McDonald M, Moore M, Johnstone P (2012) Risk of carotid blowout after reirradiation of the head and neck: a systematic review. Int J Radiat Oncol Biol Phys 82(3):1083–1089. https://doi.org/10.1016/j.ijrobp.2010.08.029
Sabra R, Taha M, Hamdy T, Rabie H, Riad M (2016) Pectoralis major flap reconstruction in the prevention of wound breakdown and fistula formation after salvage laryngectomy: a controlled study. Egypt J Otolaryngol 32(1):32. https://doi.org/10.4103/1012-5574.175803
Authors would like to thanks Dr. Srinath Thakur, Principal, SDM college of dental sciences Dharwad and Dr. Niranjan Kumar, Medical Director, SDM craniofacial research centre Dharwad for the encouragement and facilities provided.
This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.
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Anehosur, V., Dikhit, P.S., Nagraj, N. et al. PMMC Flap Revisited and its Clinical Outcome in 150 Patients. J. Maxillofac. Oral Surg. 19, 26–31 (2020). https://doi.org/10.1007/s12663-019-01228-7
- PMMC flap
- Reconstruction of oral cavity
- Complications of PMMC flap
- Pectoralis major myocutaneous flap