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: 2.64). 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.

PECTORALIS MAJOR AND OTHER MYOFASCIAL/
MYOCUTANEOUS FLAPS IN HEAD AND NECK CANCER
RECONSTRUCTION: EXPERIENCE WITH
437 CASES AT A SINGLE INSTITUTION
Jose´ Guilherme Vartanian, MD, Andre´ Lopes Carvalho, MD, PhD, Solange Maria T. Carvalho, MD,
Lia Mizobe, DDS, Jose´ Magrin, MD, PhD, Luiz Paulo Kowalski, MD, PhD
Head and Neck Surgery and Otorhinolaryngology Department, Centro de Tratamento e Pesquisa
Hospital do Caˆncer A. C. Camargo, Rua Professor Antonio Prudente, 211, 01509-900-Sa˜ o Paulo, Brazil.
E-mail: lp
_
kowalski@uol.com.br
Accepted 11 May 2004
Published online 3 August 2004 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/hed.20101
Abstract: Background. Pectoralis major and other myofas-
cial/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.
Methods. We retrospectively analyzed the records of pa-
tients with head and neck cancer who underwent an immediate
reconstruction with pectoralis major or other myofascial/myocu-
taneous flaps at a tertiary cancer center from 1982 to 1998.
Results. A total of 437 patients were reviewed. Three hun-
dred seventy-one patients underwent pectoralis major myocuta-
neous 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 (T3T4 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 pa-
tients (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.
Conclusion. 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. A 2004 Wiley Periodicals, Inc. Head Neck
26: 1018 1023, 2004
Keywords: head and neck neoplasms; head and neck
reconstruction; pectoralis major myocutaneous flap; pedicled
flap; complications
Pedicled myocutaneous flaps have been recog-
nized as one of the most important reconstruc-
tive methods in major head and neck cancer
surgery. Since the first description by Ariyan
1
in
the 1970s, the pector alis major myocutaneous
flap has been the most commonly used. The
main reasons for this are the simple technical
aspects, versatility, and prox imity to the head
and neck region.
2–5
However, in the past two
decades, reconstruction with microsurgical free
flaps has been broadly used. The free flaps can
Correspondence to: L. P. Kowalski
B 2004 Wiley Periodicals, Inc.
HEAD & NECK December 20041018 Myocutaneous Flaps
Page 1
reconstruct larger head and neck tridimensional
defects with significantly lower morbidity and
complication rates to the donor and receptor
sites and usually better functional and cosmetic
outcome compared with myocutaneous pedicled
flaps.
6–8
At present, it is considered the best op-
tion in major reconstructions. Unfortunately, a
specialized surgical team and costly instrumen-
tation are required, and these are not available
in many head and neck services. Therefore, the
pectoralis major myocutaneous flap remains the
mainstay reconstructive method in several cen-
ters worldwide.
4,9
Even at head and neck surgery services in
which free flaps are used, the pectoralis major and
other myocutaneous flaps can be performed in
combination with free flaps to reconstruct larger
defects, to protect important vessels at risk for
complications, and to treat or prev ent complica-
tions of wound breakdown.
10
These data rein-
force the concept that myocutaneous flaps are
a valuable tool in head and neck cancer surgery.
The objec tive of this study was to analyze a
large experience of a single institution with
myocutaneous flaps in head and neck cancer re-
construction. Most of the pectoralis major flaps
were tra nsferred through a subclavicular tunnel.
PATIENTS AND METHODS
A retrospective analysis of patients with head and
neck cancer treated in our institution from 1982
to 1998 was performed. All charts were reviewed,
and the tumors were restaged according to the
TNM classification of the Union Internationale
Contre le Cancer (UICC) 2002 criteria. Patients
eligible for the analysis were those with malig-
nant tumors of the head and neck who under-
went an imme diate reconstruction with use of
the pectoralis major myocutaneous flap. We also
compared the results of reconstructions with the
other types of pedicled myofascial/myocutaneous
flaps in the same p eriod. These other flaps
included platysma, pectoralis minor, trapezius,
infrahyoid, temporal, latissimus dorsi, and ster-
nocleidomastoid flaps.
The technical details of the pectoralis major
myocutaneous flap rotation were previously de-
scribed by Azevedo
11
(from our hospital) in 1986,
and some steps are important and are empha-
sized. In most patients, surgeons performed an
island flap, partially preserving the upper part of
pectoralis major muscle with a low skin incision
(Figure 1), and the flap was then transferred to
the head and neck region through a subclavic-
ular route (Figure 2). The subclavian muscle is
divided, and the subclavicular tunnel is enlarged
by digital maneuvers. In difficult cases, as in
patients with bulky flaps, sterile liquid Vaseline
is used to lubricate the flap and the ipsilateral
shoulder is raised to facilitate the tunnel passa ge.
During the procedure, a vasodilato r substance
(papaverine or lidocaine) is instilled over the flap
pedicle. Two hundred thirteen flaps were done
with this technique. In 110 cases at the surgeon’s
description, it was transferred over the clavicle,
mostly because of a bulky flap. In 48 cases, the
route used to transfer the flap was not reported in
the medical chart.
FIGURE 1. Low skin incision for pectoralis major flap.
FIGURE 2. Flap passage through a subclavicular tunnel. The
arrow shows flap pedicle under the clavicle.
Myocutaneous Flaps HEAD & NECK December 2004 1019
Page 2
Database and analysis were performed with
the SPSS Statistical Program for Windows (ver-
sion 10.0). A descriptive analysis of the results
was perfor med. Comparisons among different
variables associated with complications were per-
formed with the chi-square test.
RESULTS
The medical charts of 437 patients were reviewed.
Three hundred seventy-one patients (84.9%) un-
derwent a pectoralis major myocutaneous flap,
and 66 patients (15.1%) underwent other types
of pedicled myofascial/myocutaneous flaps: 19 in-
frahyoid, 17 platysma, nine latissimus dorsi, nine
pectoralis minor, six trapezius, three sternoclei-
domastoid, and three temporal flaps.
FIGURE 3. Mucosal defect reconstruction.
Table 2. Flap-related complication rates.
No. patients (%) by flap
Complication Pectoralis major Other flaps
Fistula 44 (11.8) 5 (7.1)
Partial necrosis 36 (9.7) 8 (11.4)
Infection 31 (8.3) 13 (18.6)
Dehiscene 10 (2.8) 3 (4.3)
Total necrosis 9 (2.4) 9 (12.9)
Table 3. Analysis of risk factors associated with
flap complications.
Pectoralis major Other flaps
Risk factor
No.
complications
(%)
p
value
No.
complications
(%)
p
value
Age, y
<70 123/338 (36.4) .727 35/60 (58.3) .051
>70 11/33 (33.3) 1/6 (16.7)
Sex
Male 122/335 (36.4) .845 28/44 (63.6) .036
Female 14/36 (38.8) 8/22 (36.4)
Defect coverage
Skin 20/62 (32.3) .582 10/14 (71.4) .301
Mucosal 102/280 (36.4) 24/49 (49.0)
Previous treatment
Surgery 109/304 (35.9) .779 3/4 (75.0) .480
Radiation 14/34 (41.2) 0/1 (0.0)
Combined 11/33 (33.3) 4/6 (66.7)
Period of surgery
1980s 32/60 (53.3) .002 16/24 (66.7) .135
1990s 102/331 (32.8) 20/42 (47.6)
Flaps
Pectoralis major 134/371 (36.1) .004
Other flaps 36/66 (54.5)
Table 1. Patient-related and tumor-related characteristics.
No. patients (%) by flap*
Variable Pectoralis major Other flaps
Sex
Male 335 (90.3) 44 (66.7)
Female 36 (9.7) 22 (33.3)
Age, y 24 91 (median, 56) 9 85 (median, 57)
Race
White 310 (83.6) 63 (95.5)
Nonwhite 61 (16.5) 3 (4.5)
Site
Oral cavity 190 (51.2) 26 (39.4)
Oropharynx 56 (15.1) 15 (22.8)
Larynx/hypopharynx 62 (16.7) 9 (13.5)
Parotid 14 (3.8) 2 (3.0)
Skin 3 (0.8) 3 (4.5)
Other 46 (12.4) 11 (16.8)
T classification
T1/T2 33 (8.9) 13 (19.7)
T3/T4 226 (60.9) 39 (59.1)
Tx 112 (30.2)y 14 (21.2)z
*
Values represent number of patients (%) except as otherwise noted.
y
Tx, T classification not possibl e to evaluate (29 patients) and patients
previously treated (16 with surgery, 34 with radiotherapy, and 33 with
surgery plus radiotherapy).
z
Tx, T classification not possible to evaluate (two patients) and patients
previously treated (four with surgery, two with radiotherapy, six with
surgery plus radiotherapy).
HEAD & NECK December 20041020 Myocutaneous Flaps
Page 3
Most of th e 371 patients who underwent th e
pectoralis major myocutaneous flap reconstruc-
tion were men (n = 335; 90.3%), with a median
age of 56 years, and 83.6% were white. Most
tumors were located in the oral cavity and oro-
pharynx (n = 246; 66.3%). The histologic diagno-
sis was squamous cell carcinoma in 337 cases
(90.8%). Most tumors were at an advanced clini-
cal stage at presentation (T3 and T4 in 60.6% of
cases). Eighty-three patients (22.4%) had under-
gone a previous treatment, which in most cases
included radiotherapy (Table 1). The flaps were
used to reconstruct mucosal defects in 280 pa-
tients (75.5%) (Figure 3), skin defects in 62 pa-
tients (16.7%), and both in 29 patients (7.8%). In
21 patients (5.7%), another flap or graft was per-
formed in association with the pectora lis major
flap, and in 30 patients (8.1%), a metal plate to
reconstruct the mandible was used. The follow-up
period ranged from 3 to 148.4 months.
The overall complication rate in patients with
pectoralis major flaps was 36.1%, including only
nine cases (2.4%) with total necrosis. Other com-
plications included partial necrosis, infec tion,
salivary fistula, and dehiscence (Table 2). Eight
postoperative deaths (2.2%) occurred, but in just
one case could the death be related to flap com-
plications. This patient was seen with a total flap
necrosis, leading to infection at the surgical site
and sepsis.
The flap-related complications were compared
with regard to patient age (V70 vs >70 years), sex,
skin or mucosal defects, and previous treatment
with radiotherapy, and no statistically significant
differences were observed. The complication rate
in these patients was significantly lower than that
in patients with other types of pedicled myocuta-
neous flaps ( p = .004). The incidence of flap
complications differed significantly by the period
during which the procedure was performed (ie,
1980s vs 1990s; p = .002) (Table 3). There was no
association between the route of the pectoralis
major flap transfer to the head and neck region
and the rates of necrosis. Of nine cases of total
flap losses, three occurred in patients with flap
passage over the clavicle, and four occurred in
patients with flap passage under the clavicle. In
the remaining two patients, this information was
unavailable from the medical charts. Also, the
complications were not influenced by the tech-
nique of flap transfer (Table 4).
DISCUSSION
It is currently broadly accepted that the versatile
free flaps with microsurgical vascular anasto-
mosis are the preferred methods for major de-
fect reconstruction in patients who undergo head
and neck cancer surgery.
6–8
However, free flaps
demand spec ialized surgical skills, special and
costly instrumentation, and rigor ous postopera-
tive monitoring. These factors are not available
in many head and neck centers,
4,9
especially in
developing countries. Also, the cost involved in
this type of procedure has been debated in the
world literature. Tsue et al
8
reported a possible
increase in cost, but better functional results and
low complication rates with free flaps compared
with pedicled myocutaneous flaps that could jus-
tify its use. Kroll et al
7
and Funk et al
12
did not
demonstrate an increase in the cost of free flaps
compared with regional pedicled flaps. However,
this topic is still at least controversial and a
matter for further debate.
The pectoralis major myocutaneous flap has
been considered a remarkable step in the history
of head and neck reconstruction since Ariyan’s
description in 1979.
1
The main advantages re-
ported are the ease of its technical aspects, the
proximity of the head and neck region, and the
possibility of obtaining a large amount of well-
vascularized tissue to cover skin and/or mucosal
defects from the neck up to the midface. Fur-
thermore, the low morbidity to the don or site and
the execution in an one-stage procedure have re-
sulted in the broad acceptance of this flap in
head and neck reconstructive surgery.
2 5,9,10,13
The pectoralis major flap can also be performed in
association with free flaps, usually to offer a soft
tissue component to a large reconstruction, to
protect major vessels at risk for rupture, and to
prevent poss ible complications of wounds with a
high risk for breakdown.
10
Also it can be used
as a salvage procedure after the necrosis of mi-
crovascularized flaps and in cases in which a
contraindication to free flaps exists, such as a
medical condition that makes the patient unable
Table 4. Complication rate comparison between pectoralis flaps
pulled up under and over the clavicle.
No. patients (%)
With
complications
Without
complications p value
Under the clavicle 72 (33.8) 141 (66.2)
Over the clavicle 42 (38.2) 68 (61.8) .716
Myocutaneous Flaps HEAD & NECK December 2004 1021
Page 4
to tolerate a long surgical procedure or inad-
equate recipient vessels in the necks of patients
who previously underwent high-dose radiother-
apy. A reported disadvantage of the pectoralis
major flap is related to the poor vascular supply
to the distal skin paddle, which can cause partial
dehiscence (mostly at the distal portion of the
flap), fistulization, and infection, resulting in a
prolonged hospital stay.
10
Regarding the technical aspects involved, in
most patients we performed an island flap with a
low skin incision at the donor site and we trans-
ferred the flap through a subclavicular tunnel to
the head and neck region. These modifications
had been previously described by Azevedo,
11,14
who emphasized that an island flap partially pre-
serves the pectoralis major muscle, decreasing the
functional impairment of the arm, and the flap
transference to the head and neck region by a
subclavicular tunnel increases the flap rotational
arc. Kerawala et al
9
also confirmed th e subcla-
vicular route as a safe procedure. Moreover, the
subclavicular passage increases its longitudinal
extent in abo ut 2 to 3 cm and also presents aes-
thetic advantages over the classical route. How-
ever, it should be noted tha t in obese patients
and patients with bulky flaps, the flap passage
through a subclavicular route will not be reliable.
In th is group of patients, the classical route (over
the clavicle) seems to be the most appropriate
method. The low skin incision could permit the
possible use of other regional flap, such as the
deltopectoral Backanjian’s flap, at the same time
or later. In our series, most flaps were performed
with a subclavicular tunnel without significant
difficulties. Comparisons of complication rates
between flaps pulled up under or over the clavi-
cle in patients for whom this information was
available in their charts showed no statistically
significant differences in the overall complication
rates or the rates of necrosis. Regarding the func-
tional results of the pectoralis major flap, be-
cause of the retrospective nature of this study,
these data were not available to clearly define
the functional morbidity involved in such a type
of reconstruction.
Within the past 20 years, other series have
reported overall complication rates ra nging from
16% to 63% of cases, the incidence of partial and
total necrosis from 4% to 29% and from 0% to 7%,
respectively, and salivary fistulas from 5% to
29%.
3 5,13,15 19
Our results showed a total com-
plication rate of 36.1%, partial necrosis of 9.7%,
total necrosis of 2.4%, and salivary fistula of
11.8%, which were similar to the published data
to date (Table 5). In the group of nine patients
(2.4%) with total flap necrosis, most had the flap
performed to cover mucosal defects after oral
tongue or oropharynx resections; there was no
history of previous treatment, and no apparent
cause was detected. Eight postoperative deaths
occurred, most related to cardiovascular events
and sepsis secondary to aspiration and pulmo-
nary infection. In just one patient was the death
associated with the total flap necrosis, fistula, and
infection at the surgical site.
Previous reports have described risk factors
associated with the development of flap compli-
cations, such as age, sex, tumor subsite, previous
radiotherapy, and comorbidities, but the results
were not similar in all series.
3 5,13,15 19
In this
study, the difference in the complication rates
between pectoralis m ajor and other regional
pedicled flaps was statistically significant. Other
advantages over the other types of pedicled myo-
fascial/myocutaneous flaps include the vers atility,
the rotational arc, and the low morbidity to the
donor site. The statistically significant difference
in complication rates between patients operated
on in the 1980s versus 1990s was considered the
Table 5. Reports about pectoralis major myocutaneous flaps and complications.
Previous report, first author (y) No. flaps Overall complication rate, % Total necrosis, % Partial necrosis, % Fistula, %
Ossoff (1983)
15
95 35.0 1.0 4.0 5.0
Shuller (1983)
3
47 40.4 4.2 4.2 19.1
Wilson (1984)
16
112 16.0 7.0 9.0 NA
Kroll (1990)
17
168 63.0 2.4 17.0 21.0
Shah (1990)
18
211 63.0 3.0 29.0 29.0
Ijsselstein (1996)
13
224 53.0 0.0 13.0 21.0
Metha (1996)
4
220 40.5 2.7 11.8 12.7
Liu (2001)
5
224 34.8 4.0 11.1 7.8
Dedivitis (2002)
19
17 41.2 5.9 5.9 11.8
Current study 371 36.1 2.4 9.7 11.8
HEAD & NECK December 20041022 Myocutaneous Flaps
Page 5
result of technical and supportive improvements
during the period analyzed, especially in anes-
thesia and perioperative clinical support.
In comparing free flaps, previous published
series reported complication rates within the
ranges of 14% to 39%,
8
with reports of flap failure
ranging from 2% to 6%,
6,7
which shows a tendency
toward lower complication rates with free flaps
compared with most reported series of pectoralis
major flaps (Table 5).
The results of our study reinforce the value of
the pectoralis major flap in the reconstruction of
head and neck defects and showed that this flap
can be done with acceptable morbidity. It also
confirms that in selected cases the subclavicular
route is safe. It usually increases the rotational
arc and axial extension of the flap, facilitating
the coverage of upper defects.
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8. Tsue TT, Desyatnikova SS, Deleyiannis FWB, et al. Com-
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11. Azevedo JF. Modified pectoralis major myocutaneous flap
with partial preservation of the muscle: a study of 55
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Smith RB. Free tissue transfer versus pedicled flap cost in
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13. Ijsselstein CB, Hovius SER, Have BLEF, et al. Is the
pectoralis myocutaneous flap in intraoral and oropha-
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15. Ossoff RH, Wurster CF, Berktold RE, et al. Complica-
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16. Wilson JSP, Yiacoumettis AM, O’Neill T. Some observa-
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17. Kroll SS, Goepfert H, Jones M, et al. Analysis of com-
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Myocutaneous Flaps HEAD & NECK December 2004 1023
Page 6
  • Source
    • "The pectoralis major musculocutaneous flap has been a workhorse in head and neck reconstruction since first report by Ariyan1 in 1979. However, the utility of this flap is limited by its unstable blood supply and the high rate of partial necrosis of the skin island, and transfer of free flaps has recently become the most common method for head and neck reconstruction.2 In particular, circumferential pharyngoesophageal defects are reconstructed almost exclusively with free enteric or fasciocutaneous flaps today. "
    [Show abstract] [Hide abstract] ABSTRACT: In the era of free-flap transfer, the pectoralis major musculocutaneous flap still plays a unique role in head and neck reconstruction. We report on a patient with a recurrent hypopharyngeal carcinoma after total pharyngolaryngectomy and adjuvant chemoradiotherapy in whom defects included a circumferential defect of the oropharynx and the entire tongue. The defects were successfully reconstructed with a T-shaped pectoralis major musculocutaneous flap whose skin island included multiple intercostal perforators from the internal mammary vessels. This flap design is effective for reconstructing circumferential pharyngeal defects in vessel-depleted neck.
    Full-text · Article · Apr 2014
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    • "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.
    Full-text · Article · Nov 2013 · International Journal of Oral and Maxillofacial Surgery
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    • "In the past, attempts were made to achieve functional restoration of resected head and neck areas with acceptable cosmesis using local and locoregional flaps. The pectoralis major myocutaneous flap (PMMF), based on the thoracoacromial artery, was described in 1979 by Ariyan (1). PMMF is well established as one of the most important reconstructive methods in major oral cancer surgery due to its simple technical aspects, versatility, and proximity to the oral cavity region (2). "
    [Show abstract] [Hide abstract] ABSTRACT: The aim of this study was to compare the differences between anterolateral thigh perforator free flaps (ALTFF) and pectoralis major myocutaneous flap (PMMF) for reconstruction in oral cancer patients. Method and Patients: who received free flap or PMMF reconstruction after ablation surgeries were eligible for the current study. The patients’ demographic data, medical history, and quality of life scores(Medical Outcomes Study-Short Form-36 (MOS SF-36) and the University of Washington Quality of Life (UW-QOL) questionnaires were collected. Results: 81 of 118 questionnaires were returned (68.64%). There was significant differences between two groups in the gender (P<0.005). Patients reconstructed with ALTFF had better appearance domains and better shoulders domains, in addition to better role emotion domains. Conclusions: Using either PMMF or ALTFF for reconstruction of oral defects after cancer resection significantly influences a patient’s quality of life. Data from this study provide useful information for physicians and patients during their discussion of reconstruction modalities for oral cancers. Key words:Quality of life, ALTFF,PMMF, oral cancer.
    Full-text · Article · Oct 2013 · Medicina oral, patologia oral y cirugia bucal
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