Retrospective analysis of pectoralis major myocutaneous flap surgeries performed under war conditions

To present our experiences in using a pectoralis major myocutaneous flap in the reconstruction of surgically created defects of the neck and lower part of the head during the war in Bosnia and Herzegovina.

Retrospective analysis of medical records from 15 patients treated at the ENT Department, Tuzla University Hospital, between January 1992 and December 1996.

Ten flaps were prepared during basic operation ("one step reconstruction of defect") and five flaps three weeks after the removal of tumor (postoperative pharyngocutaneous fistula was the reason for secondary flap preparation). The necessary time for flap preparation and its accommodation in the defect was 2 hours. The most frequent complications included seroma of donor site (6/13), fistula (3/13), partial necrosis of the flap (2/13), and total necrosis of the flap (2/13). Three patients died in the postoperative period because of a cardiac arrest but the flaps accepted correctly.

The pectoralis major myocutaneous flap is a good solution for covering defects of the neck and lower region of the head. Military blockade with extremely difficult conditions and lack of experience were the reason of the higher complication rate than those from literature.