Reconstruction plate In the Substance of Pectoralis Major Myocutaneous Flap for Reconstruction of the Mandibular Arch...

The gold standard for central arch defects of the mandible is reconstruction with vascularized bone free flap. Free flap repair is always not an option due to lack of resources and in patients who are not healthy enough for lengthy surgery. In these situations, a standardized method of repair is by reconstruction plate and wrapping it with a regional flap like pectoralis major myocutaneous flap (PMMC). However, this method of repair has increased risk of plate exposure, plate fracture, partial or complete flap necrosis, and delayed decannulation, swallowing, adjuvant treatment. Hence, we describe a new technique of incorporating titanium Reconstruction plate in the Substance of PMMC (RISP technique) and address the drawbacks of the conventional method. The aim of the study is (1) to assess the feasibility of a novel method for mandibular reconstruction that incorporates a reconstruction plate within the substance of PMMC and (2) to compare the conventional method of repair of wrapping the reconstruction plate with RISP technique. Our case series of 22 patients who had arch mandibulectomy for cancer of oral cavity serves as the basis for our description of a novel technique of Recon plate in the Substance of PMMC (RISP technique) in 15 cases and comparison with 7 cases of old conventional technique for arch defects. A total of 22 eligible patients were included in the study. Of the 22 patients, 8 were males and 14 were females. Majority of the patients were above 55 years (n = 15, 68.1%); median age in RISP technique cohort is 64 years and 57 years in conventional technique. The mean duration of follow-up for the cohort was 27 months (7-47 months). The most common subsite was the buccal mucosa (n = 9, 40.9%). Majority of the patients had squamous cell carcinoma as histology except one had osteosarcoma. Plate-related morbidities were more commonly seen with conventional method (6 out of 7 had plate exposure). Flap-related morbidities were similar in both techniques. On multivariate analysis, technique of plating was the only factor predictive of plate-related complications (p < 0.001). The average time to starting oral feeds was 15 to 25 days for patients who have undergone plating with new technique as compared to 19-90 days for patients with conventional method. Patients operated with the newer technique had earlier decannulation and shorter duration of hospital stay when compared to conventional method. The average Functional Oral Intake Score was 5 to 6 in RISP technique. Our novel technique of inserting reconstruction plate within the substance of PMMC is a feasible alternative for mandibular arch defects with less complications and better functional outcome.