Shoulder morbidity after pectoralis major flap reconstruction

Donor site morbidity of pectoralis major pedicled flap (PMPF) is scarcely studied.

A cross-sectional study on patients who underwent reconstructive surgery with a PMPF at least 6 months before was performed. Patients with a similar type neck dissection on both sides and PMPF on one side (n = 9) were assigned to group 1; patients with neck dissection and PMPF (n = 26) were assigned to group 2; and neck dissection only (n = 47) were assigned to group 3. All 3 groups filled out a shoulder disability questionnaire and underwent shoulder function tests. Pain of the shoulder was rated on a visual analog scale (VAS). Patients were also asked if they had experienced stiffness of the shoulder during the previous week. Range of motion (ROM) of the shoulder was examined by one single examiner using an inclinometer, in accord with a standardized protocol. Radical neck dissection (RND), modified radical neck dissection (MRND), and selective neck dissection (SND) sides were separately analyzed.

In group 2, shoulder morbidity was experienced more often (p = .065) than in group 3, particularly at the sides where an SND was performed (p = .010). Significant differences in prevalence of shoulder stiffness between PMPF and neck dissection sides and neck dissection only sides were found in the RND (p = .001) and MRND (p = .004) groups, but not in the SND group. A lower ROM of abduction (p = .026) was found in group 2 as compared to group 3.

Patients frequently have additional shoulder morbidity after PMPF harvest, particularly after SND. PMPF harvest adds to impairment of abduction. © 2016 Wiley Periodicals, Inc. Head Neck 38:1221-1228, 2016.