Article

Pectoralis major and other myofascial/myocutaneous flaps in head and neck cancer reconstruction: Experience with 437 cases at a single institution

Head and Neck Surgery and Otorhinolaryngology Department, Centro de Tratamento e Pesquisa Hospital do Câncer A. C. Camargo, São Paulo, Brazil.
Head & Neck (Impact Factor: 3.01). 01/2005; 26(12):1018-23. DOI: 10.1002/hed.20101
Source: PubMed

ABSTRACT Pectoralis major and other myofascial/myocutaneous flaps have been recognized as important reconstructive methods in head and neck cancer surgery. Even with the worldwide use of free flaps, they are still the mainstay reconstructive procedures in many centers.
We retrospectively analyzed the records of patients with head and neck cancer who underwent an immediate reconstruction with pectoralis major or other myofascial/myocutaneous flaps at a tertiary cancer center from 1982 to 1998.
A total of 437 patients were reviewed. Three hundred seventy-one patients underwent pectoralis major myocutaneous flaps; of these, 335 (90.3%) were men, with a median age of 56 years (range, 24-91 years). Tumors were located at the oral cavity and oropharynx in 246 patients (66.3%). Most tumors were at an advanced stage at presentation (T3-T4 in 60.9%). The flaps were used to cover mucosal defects in 280 patients (75.5%), skin defects in 62 patients (16.7%), and both in 29 patients (7.8%). In most patients, the flap was transferred to the head and neck region through a subclavicular tunnel. The overall complication rate was 36.1%, with 2.4% of cases involving total flap necrosis.
To date, this is the largest published series of patients who underwent reconstruction with a pectoralis major flap. Our results show that this flap remains an important reconstructive method, and it can be done with low risk and acceptable morbidity.

Download full-text

Full-text

Available from: José Guilherme Vartanian, Aug 23, 2015
1 Follower
 · 
121 Views
  • Source
    • "The majority (88.3%) of patients with a primary SCC (n = 77) had stage 4 disease (n = 68), with 79.2% either T3 (n = 5) or T4 (n = 56) size tumours, and this was often combined with substantial co-morbidity (47% ASA grade 3 or 4) (Table 1). This contrasts with the second largest series of PPM flaps by Vartanian et al. 13 from Brazil in 2004, in which the incidence of advanced T3 or T4 tumours was lower (61% compared with 79.2%). In addition, in a series of 70 free and PPM flaps by Mallet et al. 5 from France in 2009, fewer patients had T3 or T4 (59%) tumours, and the level of substantial comorbidity was lower (ASA grade 3, 26% compared with 45%). "
    [Show abstract] [Hide abstract]
    ABSTRACT: There are few studies reporting the role of the pedicled pectoralis major (PPM) flap in modern maxillofacial practice. The outcomes of 100 patients (102 flaps) managed between 1996 and 2012 in a UK maxillofacial unit that preferentially practices free tissue reconstruction are reported. The majority (88.2%) of PPM flaps were for oral squamous cell carcinoma (SCC), stage IV (75.6%) disease, and there was substantial co-morbidity (47.0% American Society of Anesthesiologists 3 or 4). The PPM flap was the preferred reconstruction on 80.4% of occasions; 19.6% followed free flap failure. Over half of the patients (57%) had previously undergone major surgery and/or chemoradiotherapy. Ischaemic heart disease (P=0.028), diabetes mellitus (P=0.040), and methicillin-resistant Staphylococcus aureus (MRSA) infection (P=0.013) were independently associated with flap loss (any degree). Free flap failure was independently associated with total (2.0%) and major (6.9%) partial flap loss (P=0.044). Cancer-specific 5-year survival for stage IV primary SCC and salvage surgery improved in the second half (2005-2012) of the study period (22.2% vs. 79.8%, P=0.002, and 0% vs. 55.7%, P=0.064, respectively). There were also declines in recurrent disease (P=0.008), MRSA (P<0.001), and duration of admission (P=0.014). The PPM flap retains a valuable role in the management of advanced disease combined with substantial co-morbidity, and following free flap failure.
    International Journal of Oral and Maxillofacial Surgery 11/2013; 43(5). DOI:10.1016/j.ijom.2013.10.009 · 1.36 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This chapter discusses the unique challenges in the diagnosis, workup, treatment and follow-up of patients who may have, or have failed chemoradiation protocols. The role of various imaging modalities, particularly PET scanning, is reviewed. Surgical salvage in this population is emphasized, addressing the extent of resection both at the primary site and the neck, and the surgical complications encountered in this population. Options for surgical reconstruction are discussed, including free tissue transfer. While surgical salvage is the main focus of this chapter, other salvage modalities available to patients who have been previously chemoirradiated are examined. These include ­re-irradiation with or without chemotherapy, brachytherapy and photodynamic therapy. Finally, the treatment outcomes with respect to morbidity and mortality in this population are reviewed.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Summary form only given. The lower troposphere inhomogeneities, especially ducting, play a dominant role in the design of radar and communication systems working in microwave frequency range over the sea. The available experimental data point to the high probability of temperature inversions and quick humidity decrease for the Black sea region giving rise to over sea duct appearance. It is of great importance to have reliable on-line evaluation of the propagation parameters under local conditions. In this report results are presented from a theoretical investigation of the effect of the microwave backscattering coefficient amplification within an "evaporation" duct. Using seven rays modification of the tree rays propagation model assessment of the maximal possible microwave backscattering coefficient amplification is obtained for both coherent and incoherent components of the scattered electromagnetic field under the idealized assumption of identical upper and lower boundaries. The radiating aerial is supposed submerged within the guiding structure. The computer modeling indicates a more than twenty times amplification factor for the backscattering coefficient for every common target under strong ducting. This very high amplification is due to the interference of the coherent components of the backscattered field and decreases strongly with the increase of the incident angle above the grazing sector. A comparison, with some experimental data is discussed in order to put in practical application the obtained theoretical results
    Applied Electromagnetism, 2000. Proceedings of the Second International Symposium of Trans Black Sea Region on; 02/2000
Show more