Lymphoscintigraphy in pectoralis major myocutaneous flaps

Area of Science:

• Oncology
• Surgical Oncology
• Plastic Surgery

Background:

• Myocutaneous flaps are crucial for reconstructing defects after advanced cancer surgery.
• Tumor recurrence is common in these patients, necessitating understanding of lymphatic spread.
• Reconstructive techniques may influence the pathways of cancer metastasis.

Purpose of the Study:

• To investigate lymphatic flow and lymph node metastasis in head and neck cancer patients reconstructed with myocutaneous flaps.
• To determine if myocutaneous flaps alter the natural lymphatic drainage pathways.
• To assess the risk of lymphatic spread to internal mammary nodes via the flap.

Main Methods:

• Study included five patients with head and neck cancer undergoing myocutaneous flap reconstruction.
• Lymphatic flow was visualized using Technetium Tc99m-labeled dextran.
• Lymph node visualization utilized Technetium Tc99m rhenium sulfur colloid for neck and flap regions.

Main Results:

• Newly formed lymphatic channels were observed not to penetrate the fibrotic boundaries between flap and host tissues.
• Lymphatic metastasis to internal mammary nodes was only evident when recurrent tumors directly invaded the myocutaneous flap.
• The study highlights altered lymphatic pathways post-myocutaneous flap reconstruction.

Conclusions:

• Myocutaneous flaps create a barrier to natural lymphatic flow, redirecting or limiting metastasis.
• Direct tumor invasion of the flap is a prerequisite for lymphatic spread to internal mammary nodes.
• Understanding these altered lymphatic dynamics is vital for managing recurrent cancer in head and neck reconstructions.