Has the Pectoralis Major flap Really Become Obsolete?

Area of Science:

• Plastic Surgery
• Head and Neck Reconstruction
• Reconstructive Surgery

Background:

• The pectoralis major (PM) flap is a reconstructive option in head and neck surgery.
• Its current role and comparison with free flaps require evaluation.

Purpose of the Study:

• To assess the current utility of the pectoralis major (PM) flap.
• To identify reasons for selecting the PM flap over free flaps in head and neck reconstruction.

Main Methods:

• A retrospective study of patients undergoing PM flap reconstruction at Apollo Hospitals Ahmedabad from January 2020 to December 2022.
• Analysis of patient demographics, tumor characteristics, complications, and reasons for flap selection.
• Comparison of outcomes with free flap reconstructions.

Main Results:

• 57 patients underwent PM flap reconstruction; 154 underwent free flap reconstruction.
• The PM flap had a significantly lower rate of complete flap necrosis (0% vs. 9.74% for free flaps, p=0.012).
• Common reasons for PM flap use included comorbidities, extensive disease, salvage, vessel unavailability, and financial constraints.

Conclusions:

• The pectoralis major (PM) flap is not obsolete and remains a viable and important option for head and neck reconstruction.
• Its selection is often influenced by patient comorbidities, disease extent, and resource availability.