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Pectoralis major myocutaneous flap: analysis of complications in difficult patients
M L Castelli1, G Pecorari, G Succo
1First ENT University Department, University of Turin, Italy. casterr@libero.it
Abstract:
The purpose of this study was to assess and discuss the effects of old age and systemic diseases on complications related to the use of a pectoralis major myocutaneous flap (PMMF) for reconstruction in head and neck surgery. Eighty-four consecutive patients, operated on between January 1992 and December 1998, were included in the study. Of these patients, 47 were in relatively good condition, while 37were old and frail or affected by systemic diseases. Patients were monitored for complications during a follow-up of 2 years. All patients included in the study had very advanced squamous cell carcinomas (T3-T4) and reconstruction with PMMF was performed after a commando procedure, a total laryngectomy with partial pharyngectomy, or a composite resection. Necrosis of skin island was the most frequently encountered complication, but no surgical intervention was needed. Overall, complications occurred more frequently in patients with underlying pathologies, the risk ratio adjusted for age and sex being 2.94, but 95% confidence intervals were 0.99-8.65 and all complications were minor. In summary, we recommend the use of PMMF for immediate repair in difficult patients who have large oropharyngo-laryngeal excisions and radical neck dissections and who suffer concomitantly with various medical problems known to increase complication rates. PMMF proved to be suitable to give these patients good chances of a quick recovery with satisfactory aesthetic and functional results.
Insights
Pectoralis major myocutaneous flap (PMMF) reconstruction is safe for head and neck cancer patients with systemic diseases. While complications are more frequent in these patients, they are typically minor, allowing for good recovery.
Area of Science:
- Head and Neck Surgery
- Reconstructive Surgery
- Oncology
Background:
- Head and neck cancer surgery often requires extensive tissue resection.
- Reconstruction of large defects can be challenging, especially in elderly or medically compromised patients.
Purpose of the Study:
- To evaluate the safety and efficacy of pectoralis major myocutaneous flap (PMMF) reconstruction in head and neck cancer patients.
- To assess the impact of advanced age and systemic diseases on PMMF reconstruction outcomes.
Main Methods:
- Retrospective analysis of 84 patients undergoing PMMF reconstruction after head and neck cancer surgery.
- Patients were categorized based on age and presence of systemic diseases.
- Complications were monitored over a 2-year follow-up period.
Main Results:
- The pectoralis major myocutaneous flap (PMMF) was used for reconstruction in patients with advanced squamous cell carcinomas (T3-T4).
- Skin island necrosis was the most common complication, but did not require surgical intervention.
- Complications occurred more frequently in patients with systemic diseases (risk ratio 2.94), but all were minor.
Conclusions:
- Pectoralis major myocutaneous flap (PMMF) is a suitable option for reconstructing large head and neck defects in patients with systemic diseases.
- This flap provides satisfactory aesthetic and functional results, promoting quicker recovery even in high-risk patients.