Pectoralis Major Myocutaneous Flap in Reconstruction of Defects after Head and Neck Oncological Resections - Gender...

Head and neck malignancies significantly contribute to the cancer burden among women in South India mainly due to the tobacco chewing pattern prevalent in them.The use of pectoralis major myocutaneous flap for post surgical defect reconstruction is more challenging in them owing to their donor area anatomy. We aimed to analyse and compare the clinical profile and post operative outcome of male and female patients undergoing pectoralis major myocutaneous flap reconstruction for oncological head and neck resections. We retrospectively analysed the records of male and female patients who underwent PMMC flap reconstruction in our institution during 2022-24 and assessed their outcome perioperatively and after 6 months of follow up and drew comparisons. Sixty six patients underwent PMMC flap reconstruction during the two year period. Out of them, 37 (56.1%) were women and 29 (43.9%) were men. Median age among females and males were 58 y and 54.8 years respectively. Buccal mucosa was the predominant primary site in both but constituted a higher proportion in female patients. (46% vs. 34%), followed by lower alveolus. Overall, 26 inlay, 5 overlay and 35 bipaddled flaps were done.54% of defects in female patients required bipaddled flaps for closure. Mean operating time was 219 min & 196 min for female and male patients respectively. All female patients had their donor sites closed primarily ; 30% of males required split skin grafts. In the early post operative period, minor complications ( wound infection, partial necrosis ) occured in 30% patients overall. (32% among females, 27% among males) which were successfully managed conservatively. Flap loss necessitating alternate cover occured in 6% - 4 patients( 2 males, 2 females). On follow up at 6th month, both subgroups had satisfactory functional shoulder outcomes as determined by range of movements. The pectoralis major myocutaneous flap provides reliable results in both gender groups inspite of technical difficulties in female patients.