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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

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Abstract

Reconstruction of large and complex defects arising from resection of advanced oral cancers requires free flaps or multi-staged reconstructions using a combination of pedicled flaps. Bipaddle (pectoralis major myocutaneous (PMMC) flap is a good alternative for reconstruction of such defects, especially in low-middle–income countries (LMIC). However, care should be taken while expanding its limits to avoid unnecessary morbidity. We discuss technical considerations while extending the PMMC flap design beyond the usual boundaries and analyse surgical and quality of life (QOL) outcomes in our patients with large (≥ 10 cm) oral cavity defects while using extended bipaddle PMMC flaps. We retrospectively analysed the results of 72 oral cancer patients with large buccoalveolar defects with at least one dimension ≥ 10 cm who underwent single-stage reconstruction using extended bipaddle PMMC flaps between January 2018 and December 2019. Total flap loss was seen in one patient and partial loss in 10 (13.8%) patients, while 18 (25.1%) patients had major complications (Clavien-Dindo grade III). Discharge from hospital was delayed beyond a mean of 6 days in 15 (20.8%) patients and the start of adjuvant treatment was delayed in 5 patients (6.9%). On univariate analysis, age > 50 years, female gender, the largest dimension and flap area were significant factors increasing morbidity. The QOL outcomes were acceptable. The satisfactory results from our series reaffirm that extended bipaddle PMMC flaps are a viable alternate option for such reconstructive challenges in resource-limited centres. However, age, gender, the defect dimensions and flap area should be taken into consideration while using this flap.

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References

  1. Bray F, Ferlay J, Soerjomataram I, Siegel R, Torre L, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6):394–424

    Article  Google Scholar 

  2. Bhanja A, D'Souza D, Roy C, Poddar R (2016) Reliability of the pectoralis major myocutaneous flap in reconstructive oral cancer surgery in developing countries: our experience. Medical Journal Armed Forces India 72:S1–S7

    Article  Google Scholar 

  3. Wei F-C, Demirkan F, Chen H-C, Chen I-H (1999) Double free flaps in reconstruction of extensive composite mandibular defects in head and neck cancer. Plast Reconstr Surg 103(1):39–47

    Article  CAS  Google Scholar 

  4. Cordeiro PG, Disa JJ, Hidalgo DA, Hu QY (1999) Reconstruction of the mandible with osseous free flaps: a 10-year experience with 150 consecutive patients. Plast Reconstr Surg 104:1314–1320

    Article  CAS  Google Scholar 

  5. Deschler DG, Hayden RE (2000) The optimum method for reconstruction of complex lateral oromandibular-cutaneous defects. Head Neck 22:674–679

    Article  CAS  Google Scholar 

  6. Blackwell KE, Buchbinder D, Biller HF, Urken ML (1997) Reconstruction of massive defects in the head and neck: the role of simultaneous distant and regional flaps. Head Neck 19:620–628

    Article  CAS  Google Scholar 

  7. Bjordal K, Hammerlid E, Ahlner-Elmqvist M, de Graeff A, Boysen M, Evensen JF, Biörklund A, de Leeuw JRJ, Fayers PM, Jannert M, Westin T, Kaasa S, for the EORTC Quality of Life Group (1999) Quality of life in head and neck cancer patients: validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire H&N35. J Clin Oncol 17:1008–1019

    Article  CAS  Google Scholar 

  8. 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. Modern Plastic Surgery 02(04):103–107

    Article  Google Scholar 

  9. Ahmad QG, Navadgi S, Agarwal R, Kanhere H, Shetty KP, Prasad R (2006) Bipaddle pectoralis major myocutaneous flap in reconstructing full-thickness defects of the cheek: a review of 47 cases. J Plast Reconstr Aesthet Surg 59:166–173

    Article  Google Scholar 

  10. Sharan R, Attakkil A, Manikantan K, Arun P (2019) Novel technique to increase the PMMC flap pedicle length by coplanar rotation along the pedicle axis. Journal of Maxillofacial and Oral Surgery 18(4):637–639

    Article  Google Scholar 

  11. Dhiwakar M (2013) Extended pectoralis major myocutaneous flap in head and neck reconstruction. World Journal of Otorhinolaryngology 3(3):108

    Article  Google Scholar 

  12. 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 146:478–482

    Article  Google Scholar 

  13. Brusati R, Collini M, Bozzetti A, Chiapasco M, Galioto S (1988) The pectoralis major myocutaneous flap. Experience in 100 consecutive cases. J Craniomaxillofac Surg 16:35–39

    Article  CAS  Google Scholar 

  14. Vartanian JG, Carvalho AL, Carvalho SMT, Mizobe L, Magrin J, Kowalski LP (2004) Pectoralis major and other myofascial/myocutaneous flaps in head and neck cancer reconstruction: experience with 437 cases at a single institution. Head Neck 26(12):1018–1023

    Article  Google Scholar 

  15. Zbar RIS, Funk GF, McCulloch TM, Graham SM, Hoffman HT (1997) Pectoralis major myofascial flap: a valuable tool in contemporary head and neck reconstruction. Head Neck 19(5):412–418

    Article  CAS  Google Scholar 

  16. Rikimaru H, Kiyokawa K, Inoue Y, Tai Y (2005) Three-dimensional anatomical vascular distribution in the pectoralis major myocutaneous flap. Plast Reconstr Surg 115:1342–1352

    Article  CAS  Google Scholar 

  17. Kroll S, 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

    Article  CAS  Google Scholar 

  18. Tripathi M, Parshad S, Karwasra RK, Singh V (2015) Pectoralis major myocutaneous flap in head and neck reconstruction: an experience in 100 consecutive cases. Natl J Maxillofac Surg 6:37–41

    Article  Google Scholar 

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Acknowledgements

Ms. Neha Bandral for the schematic diagrams.

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Authors and Affiliations

  1. Department of Surgical Oncology, All India Institute of Medical Sciences Rishikesh, Rishikesh, 249203, Uttarakhand, India

    Pallvi Kaul, Dharma Ram Poonia, Rajkumar Kottayasamy Seenivasagam, Dungala Dileep Maharaj, Pankaj Kumar Garg & Satya Prakash Agarwal

  2. Department of Oto-Rhino-Laryngology & Head-Neck Surgery, All India Institute of Medical Sciences Rishikesh, Rishikesh, 249203, Uttarakhand, India

    Bhinya Ram Jat

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  1. Pallvi Kaul
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  2. Dharma Ram Poonia
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Contributions

PK, DRP and KSR have equal contribution in concept, data collection, analysis and manuscript writing. SPA, KSR and DRP contributed in the flap design and technical considerations. PKG DDM and BRJ contributed to data collection.

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Correspondence to Rajkumar Kottayasamy Seenivasagam.

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The authors declare no competing interests.

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The study was an audit and does not require institutional ethics committee (IEC) approval. Patient photographs used with informed consent and permission from IEC. Patient permission obtained.

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Kaul, P., Poonia, D.R., Kottayasamy Seenivasagam, R. et al. 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. Indian J Surg Oncol 12, 484–490 (2021). https://doi.org/10.1007/s13193-021-01345-1

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