Gómez-Pedraza Antonio1*, Herrera-Guerrero Mariana I2, Rivas León Bernardo1 and Gonzalez Zuñiga Arturo3
1Department of Head and Neck Surgery, National Cancer Institute of Mexico, Mexico
2Department of Anesthesiology, American British Cowdray Medical Center, Mexico
3Department of General Surgery, Mexican Social Security Institute, Mexico
Introduction: When the only therapeutic possibility of head and neck cancer is a wide resection, reconstruction of the defect becomes as important as eradicating it. In 1979, Ariyan described the technique of Pectoralis Major Flap (PMF), redefining the myocutaneous reconstructions and today remains as versatile resource reconstruction, technically simple, with applications in the head and neck area. However, despite the flexibility of the technique, this kind of flap has a high complication rate, 17% to 63% of the flaps will fail.
Methods: A search in the database of the Department of Head and Neck at the National Cancer Institute of Mexico was made, from January 1, 2005 to December 31, 2015, it was used as primary inclusion criteria the use of pectoralis major flap as reconstructive option for primary form or salvage. It was reported the primary site of cancer, the treatment received at the beginning, the use of pectoralis major flap, the location of the defect, the administration of adjuvant radio therapy and the number of flaps per patient. Also, the complications were reviewed. Getting all the data, descriptive statistics were performed.
Results: Thirty patients were treated with pectoralis major flap reconstruction, of which 23 were men (76.6%) and 7 women (23.4%), the average age for men was 58.5 years (28 to 84) and women 58.4 years (29 to 83). Most primary tumors are located in oral cavity (53.3%) highlighting the primary site in alveolar ridge (30%). There were performed 17 salvage surgeries (53.3%), 11 primary surgeries (36.6%) and two procedures for osteoradionecrosis. Of the 38 flaps that were made, the most frequently described complication was a partial necrosis in 12 cases (31.5%) with a single case of total necrosis (2.6%). Minor complications included 12 cases of dehiscence (31.5%), 7 cases of bleeding (28.4%), and two immediate postoperative deaths not associated with pectoralis major flap.
Conclusion: Even in the days of assisted microscope surgery and free flaps, the pectoralis major flap remains in use because of the easy technique, obviating resources not available in all institutions with multiple applications for reconstruction of defects. The most frequent complication described in the use of this flap is fistula and dehiscence, which for our population were no difference; also we show the importance of the primary tumor site and a history of chemotherapy/radiotherapy as factors associated with the presence of complications.
Pectoralis major flap; Head and neck reconstruction; Salvage surgery
Antonio H-G, Herrera-Guerrero Mariana I, Bernardo RL, Arturo GZ. Pectoralis Major Myocutaneous Flap for Head and Neck Reconstruction: Ten Years of Experience. Clin Surg. 2019; 4: 2395.