Pectoralis major myocutaneous flaps for head and neck reconstruction
factors influencing occurrences of complications and the final outcome
Keywords:
Surgical flaps, Reconstructive surgical procedures, Head and neck neoplasms, Postoperative complications, Treatment outcomeAbstract
CONTEXT AND OBJECTIVE: Pedicled flaps play an important role in cancer treatment centers, particularly in developing and emerging countries. The aim of this study was to identify factors that may cause complications and influence the final result from reconstructions using pectoralis major myocutaneous flaps (PMMFs) for head and neck defect repair following cancer resection. DESIGN AND SETTING: Cross-sectional study at the Hospital de Ensino Padre Anchieta of Faculdade de Medicina do ABC (FMABC). METHODS: Data on 58 patients who underwent head and neck defect reconstruction using PMMFs were reviewed. The final result from the reconstruction (success or failure) and the complications observed were evaluated in relation to the patients’ ages, area reconstructed, disease stage, previous oncological treatment and need for blood transfusion. RESULTS: There were no total flap losses. The reconstruction success rate was 93.1%. Flap-related complications occurred in 43.1% of the cases, and half of them were considered major. Most of the complications were successfully treated. Defects originating in the hypopharynx were correlated with the development of major complications (p = 0.02) and with reconstruction failure (p < 0.001). Previous oncological treatment negatively influenced the reconstruction success (p = 0.04). CONCLUSIONS: Since the risk factors for developing major complications and reconstruction failure are known, it is important to heed the technical details and provide careful clinical support for patients in a more critical condition, so that better results from using PMMFs can be obtained.
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Petruzzelli GJ, Brockenbrough JM, Vandevender D, Creech SD. The influence of reconstructive modality on cost of care in head and neck oncologic surgery. Arch Otolaryngol Head Neck Surg. 2002;128(12):1377-80.
Smeele LE, Goldstein D, Tsai V, et al. Morbidity and cost differences between free flap re- construction and pedicled flap reconstruction in oral and oropharyngeal cancer: Matched control study. J Otolaryngol. 2006;35(2):102-7.
Vartanian JG, Carvalho AL, Carvalho SM, et al. Pectoralis major and other myofascial/myo- cutaneous flaps in head and neck cancer reconstruction: experience with 437 cases at a single institution. Head Neck. 2004;26(12):1018-23.
Andrews BT, McCulloch TM, Funk GF, Graham SM, Hoffman HT. Deltopectoral flap revisited in the microvascular era: a single institution 10-year experience. Ann Otol Rhinol Laryngol. 2006;115(1):35-40.
Uğurlu K, Ozçelik D, Hüthüt I, et al. Extended vertical trapezius myocutaneous flap in head and neck reconstruction as a salvage procedure. Plast Reconstr Surg. 2004;114(2): 339-50.
Pinto FR, de Magalhães RP, Capelli F de A, Brandão LG, Kanda JL. Pedicled temporo- parietal galeal flap for reconstruction of intraoral defects. Ann Otol Rhinol Laryngol. 2008;117(8):581-6.
Ariyan S. The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck. Plast Reconstr Surg. 1979;63(1):73-81.
Salvatori P, Motto E, Paradisi S, et al. Oromandibular reconstruction using titanium plate and pectoralis major myocutaneous flap. Acta Otorhinolaryngol Ital. 2007;27(5):227-32.
El-Marakby HH. The reliability of pectoralis major myocutaneous flap in head and neck reconstruction. J Egypt Natl Canc Inst. 2006;18(1):41-50.
Milenović A, Virag M, Uglesić V, Aljinović-Ratković N. The pectoralis major flap in head and neck reconstruction: first 500 patients. J Craniomaxillofac Surg. 2006;34(6):340-3.
Croce A, Moretti A, D’Agostino L, Neri G. Continuing validity of pectoralis major muscle flap 25 years after its first application. Acta Otorhinolaryngol Ital. 2003;23(4):297-304.
Liu R, Gullane P, Brown D, Irish J. Pectoralis major myocutaneous pedicled flap in head and neck reconstruction: retrospective review of indications and results in 244 consecutive cases at the Toronto General Hospital. J Otolaryngol. 2001;30(1):34-40.
Shah JP, Haribhakti V, Loree TR, Sutaria P. Complications of the pectoralis major myocuta- neous flap in head and neck reconstruction. Am J Surg. 1990;160(4):352-5.
Castelli ML, Pecorari G, Succo G, et al. Pectoralis major myocutaneous flap: analysis of complications in difficult patients. Eur Arch Otorhinolaryngol. 2001;258(10):542-5.
Chepeha DB, Annich G, Pynnonen MA, et al. Pectoralis major myocutaneous flap vs revas- cularized free tissue transfer: complications, gastrostomy tube dependence, and hospitali- zation. Arch Otolaryngol Head Neck Surg. 2004;130(2):181-6.
Wadwongtham W, Isipradit P, Supanakorn S. The pectoralis major myocutaneous flap: ap-plications and complications in head and neck reconstruction. J Med Assoc Thai. 2004;87 Suppl 2:S95-9.
Tsue TT, Desyatnikova SS, Deleyiannis FW, et al. Comparison of cost and function in recons- truction of the posterior oral cavity and oropharynx. Free vs pedicled soft tissue transfer. Arch Otolaryngol Head Neck Surg. 1997;123(7):731-7.
Ariyan S. Further experiences with the pectoralis major myocutaneous flap for the imme- diate repair of defects from excisions of head and neck cancers. Plast Reconstr Surg. 1979;64(5):605-12.
Baek SM, Lawson W, Biller HF. An analysis of 133 pectoralis major myocutaneous flaps. Plast Reconstr Surg. 1982;69(3):460-9.
Nagral S, Sankhe M, Patel CV. Experience with the pectoralis major myocutaneous flap for head and neck reconstruction in a general surgical unit. J Postgrad Med. 1992;38(3):119-23.
Koh KS, Eom JS, Kirk I, Kim SY, Nam S. Pectoralis major musculocutaneous flap in oropharyn- geal reconstruction: revisited. Plast Reconstr Surg. 2006;118(5):1145-9; discussion 1150.
Saussez S, Cuno A, Urbain F, Chantrain G, Lequeux T. Reconstruction of circumferential oro- and hypopharyngeal defects with U-shaped pectoralis major myocutaneous flap. Otolaryn- gol Head Neck Surg. 2006;134(5):823-9.
Freeman JL, Walker EP, Wilson JS, Shaw HJ. The vascular anatomy of the pectoralis major myocutaneous flap. Br J Plast Surg. 1981;34(1):3-10.
Jager-Wittenaar H, Dijkstra PU, Vissink A, et al. Critical weight loss in head and neck can- cer--prevalence and risk factors at diagnosis: an explorative study. Support Care Cancer. 2007;15(9):1045-50.
Chew CT, Stanley R, Peck R, Chew SC. Pectoralis major myocutaneous flap reconstruc- tion in head and neck surgery--experience with 60 cases. Ann Acad Med Singapore. 1991;20(5):570-80.
Vendrell Marqués JB, Zapater Latorre E, Ferrandis Perepérez E, Estellés Ferriol E, Brotons Durbán S. Colgajo pediculado de pectoral mayor: nuestra experiencia en 76 casos con- secutivos [Pedicled pectoralis major musculocutaneous flaps]. Acta Otorrinolaringol Esp. 2002;53(1):39-45.
Pfuetzenreiter Júnior EG, Andrade CRA, Lehn CN, Dedivitis RA. O retalho músculo-cutâneo peitoral maior na reconstrução do câncer de cabeça e pescoço [The pectoralis major musculocutaneous flap in head and neck cancer reconstruction]. Arq Bras Ciênc Saúde. 2008;33(3):151-4.
Triboulet JP, Mariette C, Chevalier D, Amrouni H. Surgical management of carcinoma of the hypopharynx and cervical esophagus: analysis of 209 cases. Arch Surg. 2001;136(10): 1164-70.
Clark JR, Gilbert R, Irish J, et al. Morbidity after flap reconstruction of hypopharyngeal de- fects. Laryngoscope. 2006;116(2):173-81.
Magrin J, Kowalski LP, Sabóia M, Sabóia RP. Major glossectomy: end results of 106 cases. Eur J Cancer B Oral Oncol. 1996;32B(6):407-12.
Rikimaru H, Kiyokawa K, Inoue Y, Tai Y. Three-dimensional anatomical vascular distribution in the pectoralis major myocutaneous flap. Plast Reconstr Surg. 2005;115(5):1342-52; discussion 1353-4.
Rikimaru H, Kiyokawa K, Watanabe K, et al. New method of preparing a pectoralis major myocutaneous flap with a skin paddle that includes the third intercostal perforating branch of the internal thoracic artery. Plast Reconstr Surg. 2009;123(4):1220-8.
Cunha-Gomes D, Choudhari C, Kavarana NM. Vascular compromise of the pectora- lis major musculocutaneous flap in head and neck reconstruction. Ann Plast Surg. 2003;51(5):450-4.
Pinto FR, Kanda JL, Diniz MT, Santos CP, Zveibil DK. Delayed histological changes in cuta- neous portion of pectoralis major flaps employed in upper aero-digestive tract reconstruc- tion. Eur Arch Otorhinolaryngol. 2009;266(4):553-8.
