Salvage reconstruction of extensive recurrent oral cancer defects with the pectoralis major myocutaneous flap
ABSTRACT This study aimed to evaluate the usefulness of the pectoralis major myocutaneous flap for reconstruction of oral and facial defects after excision of recurrent oral cancer and the results of salvage surgery.
Twenty-four patients with recurrent squamous cell carcinoma of the oral cavity underwent salvage surgical treatment. Pectoralis major flaps were used for reconstruction of the extensive defects caused by excision of the tumors. The complications of the flap and the prognosis of the patients were analyzed with a follow-up from 5 to 65 months (mean = 18.5 months).
Fourteen flaps were used for mucosal lining of the mouth, and 10 flaps were used for reconstruction of the cutaneous defects. The overall success rate of the flap was 70.8%. Flap-related complications developed in 13 patients (54.2%). Major complications occurred in 7 patients (29.2%), and minor complications occurred in 6 (25.0%). Three patients (12.5%) had complications unrelated to the flap. The reconstruction of the base of the tongue, the floor of the mouth, and the oropharynx emerged as a significant risk factor for flap necrosis on binary logistic regression analysis (P < .05). The overall 1-, 3-, and 5-year overall survival rate was 72.8%, 30.9%, and 20.6%, respectively.
The pectoralis major myocutaneous flap is a reliable choice for reconstruction of extensive soft tissue defects caused by excision of recurrent oral cancer. The major complications correlate with the site of reconstruction. Many patients benefit from salvage surgery, and some of them can survive 2 to 4 years postoperatively.
Article: Cancro dell’orofaringe[Show abstract] [Hide abstract]
ABSTRACT: I cancri dell’orofaringe appartengono al gruppo delle neoplasie delle vie aerodigestive superiori (VADS). La loro epidemiologia ha conosciuto, negli ultimi tempi, profonde modifiche, a causa dell’aumento dei cancri orofaringei indotti dai papillomavirus umani (HPV tipo 16, soprattutto) e della riduzione della parte relativa dei tumori legati al consumo di alcol e di tabacco. Il bilancio di questi cancri deve permettere di precisare, oltre alle potenziali comorbilità del paziente, le estensioni locoregionali e a distanza che guidano la strategia terapeutica. Quest’ultima è determinata in modo collegiale da un’equipe multidisciplinare e integra in modo variabile diverse modalità terapeutiche: chirurgia, radioterapia, chemioterapia e terapie molecolari mirate. Se la chirurgia e la radioterapia possono essere utilizzate da sole per i tumori di stadio precoce, il trattamento delle forme localmente avanzate fa ricorso a delle associazioni terapeutiche complesse. Numerosi progressi terapeutici sono stati compiuti recentemente, in particolare sul piano tecnico, permettendo una migliore conservazione funzionale, garante della qualità di vita successiva dei pazienti.03/2014; 13(1):1–17. DOI:10.1016/S1639-870X(14)66949-X
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ABSTRACT: In general, the pedicled pectoralis major (PPM) flap has become a secondary choice for reconstruction in the developed world while remaining popular within the developing world. The pectoralis major flap is utilised in varying proportions as either the preferred reconstruction or for salvage reconstruction following free flap failure, further disease or complications. Refinements in surgical technique and an experienced surgeon may yield high total flap success rates with modest levels of wound complications. The pectoralis major flap is particularly useful with serious or multiple comorbidities, advanced disease, and previous surgery and/or chemoradiotherapy. It has primarily been used for reconstruction of extended radical neck dissection, posterolateral mandible, large glossectomy and oropharyngeal defects, and occasionally together with a free flap. A second free flap has increasingly been used after initial failure, particularly in the larger centres, but the PPM flap probably remains the most commonly used salvage option. The needs of the local population vary, survival outcomes are improving and patient choice may become an increasing factor in flap selection.Oral Surgery 02/2014; 7(3). DOI:10.1111/ors.12080
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ABSTRACT: Purpose: Well vascularized pectoralis major myocutaneous flap (PMMF) had been a commonly used versatile flap in reconstructive oromaxillofacial surgery since the 1970s. However, after the advent of microvascular surgery in the 1980s, the PMMF was used less frequently. But, to date, PMMF has been useful and has some advantages such as covering wide defects, covering vital structures, back-up procedure in cases of free flap failure, and reconstruction for radiotherapy patients. The purpose of this study is to evaluate the role, indication, complications, functional, and aesthetic results of this flap in the era of free flap with a literature and chart review. Methods: A retrospective study was conducted of 16 oral cancer patients undergoing reconstructive surgery with PMMF for reconstruction of defects from 2001 to 2012 at Kyungpook National University Hospital. The male to female ratio was 10:6, with a mean age of 63 years (16~79 years). Basic demographic data, previous treatment history, indications, dimension of the flap, site of reconstruction, postoperative complications, and patients' final status were systemically analyzed from chart review. Results: The pathology of the disease included squamous cell carcinoma in the majority of cases (n=14). The remaining cases were fibrosarcoma and mucoepidermoid carcinoma. Of the 16 PMMF reconstructions, 13 flaps were applied as primary reconstructive procedures, whereas three flaps were; salvage; procedures (vascularized free flap failure). Twelve patients had complications such as wound dehiscence, infection, hematoma, fistula, flap bulkiness, and partial flap necrosis. The higher complication rates showed an association with utilization of the flap in preoperative radiotherapy cases. However, all patients were discharged without failure. Conclusion: In reconstructive oromaxillofacial surgery, the PMMF is still a useful flap for huge defects. In addition, the PMMF can be used as a salvage procedure after vascularized free flap failure and reconstruction for patients with a history of preoperative radiotherapy.09/2013; 35(5). DOI:10.14402/jkamprs.2013.35.5.277