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


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.

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Available from: José Guilherme Vartanian
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    • "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. "
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    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%). "
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    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). "
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    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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