Back to the Roots-Reconstructing Full Thickness Oral Cavity Defects in Women With the Versatile Bi-Folded PMMC Flap

Full thickness defects of the oral cavity present a challenge to the surgeon for reconstruction. The advent of microsurgical vascular anastomosis has led to acceptance of free flaps as reconstructive procedures of choice for such patients. But financial constraints and resource limited settings can force us to fall back on the ever-reliable Pectoralis major myo-cutaneous (PMMC) flap. The present study aspires to analyze the complications and functional outcomes of reconstruction with bi-folded PMMC flaps in female patients.

Retrospective analysis of the data of 60 female patients who were reconstructed with bi-folded PMMC flaps over a period of 2 years between July 2020 and June 2022 was done. Data was analyzed in terms of patient factors, flap-related complications, and functional outcomes.

The overall complication rate including major/minor complications was 46.6% with flap detachment at 23.3% being the commonest complication observed. A total of 16.6% patients developed an Oro-cutaneous fistula and surgical site infection was seen in 11.66%. A total of 5% patients suffered a complete flap failure, whereas 11.66% suffered a partial flap failure. A total of 11.66% patients suffered from oral commissural incontinence and needed a redo commissuroplasty. Overall 33.33% patients were subjected to a second surgical intervention. Only 3.33% patients suffered from total inability to swallow liquids or solids. Only 6.66% patients had a completely unintelligible speech post operatively.

The PMMC flap is a robust, dependable, and economical option for reconstruction of oral cavity defects with acceptable functional outcomes in settings where the microvascular surgical facilities are unavailable or are unaffordable.