Clinical Outcome After Pedicled Segmental Pectoralis Major Island Flaps for Head and Neck Reconstruction

Corten, Eveline M. L.; Schellekens, Pascal P.A.; Hage, J. Joris; Kon, Moshe

doi:10.1097/sap.0b013e31818938bb

Cited by 23 publications

(21 citation statements)

References 21 publications

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“…Corten et al [13] and McLean et al [15] also reported that there was a significant correlation between a past history of radiotherapy and overall complications. In addition, Pinto et al [14] reported that there was a significant correlation between hypopharyngeal reconstruction and overall complications.…”

Section: Discussionmentioning

confidence: 99%

Analysis of 120 Pectoralis Major Flaps for Head and Neck Reconstruction

et al. 2012

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BackgroundA pectoralis major flap is one of the standard tools for the reconstruction of defects of the head and neck. Despite the technical advancement in free tissue transfer in head and neck reconstruction, the benefits of a pectoralis major flap should not be overlooked. The purpose of this study is to evaluate our 17 years of experience in reconstructing defects of the head and neck region using the pectoralis major flap.MethodsWe retrospectively reviewed the medical records of 112 patients (120 cases) who underwent pectoralis major flap operations for head and neck reconstruction during a period ranging from 1994 to 2010.ResultsIn our series, no total necrosis of the flap occurred. Of the total cases, 30.8% presented with flap-related complications. Major complications occurred in 20% of all of the cases but were then all successfully treated. The male sex was correlated with the occurrence of overall complications (P=0.020) and major complications (P=0.007). Preoperative albumin levels of <3.8 g/dL were correlated with the formation of fistula (P=0.030). Defects of the hypopharynx were correlated with the occurrence of major complications (P=0.019) and the formation of fistula (P=0.012). Secondary reconstructions were correlated with the occurrence of overall complications (P=0.013) and the formation of fistula (P=0.030).ConclusionsA pectoralis major flap is still considered to be a safe, versatile one-stage reconstruction procedure in the management of the defects of head and neck and the protection of the carotid artery.

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Section: Discussionmentioning

confidence: 99%

Analysis of 120 Pectoralis Major Flaps for Head and Neck Reconstruction

et al. 2012

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“…According to documented literature reports by Kiyokawa et al [17] as well as others [6,20,22,23], the use of pectoralis major myocutaneous pedicled flap has solved two important problems, the first problem is postoperative infection caused by foreign body reactions or movement between the plate and the surrounding tissue and the second problem is metal plate exposure caused by pressure applied to the skin overlying the mandible, gingiva, or grafted skin flap which can be best addressed by completely rolling the muscular tissue of the pectoralis major myocutaneous flap around the metal plate. When compared with skin or subcutaneous tissue, muscular tissue facilitates wound healing to a greater degree [22][23][24][25][26][27].…”

Section: Discussionmentioning

confidence: 99%

“…When compared with skin or subcutaneous tissue, muscular tissue facilitates wound healing to a greater degree [22][23][24][25][26][27].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Features and Management Strategy of a Refractory Case of Osteoradionecrosis of the Mandible: Case Report and Review of Literature

Jeyaraj¹,

Bandyopadhyay

2015

J. Maxillofac. Oral Surg.

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Introduction Osteoradionecrosis of the jaws produces a considerable amount of esthetic as well as functional deficits seriously affecting quality of life of the patient. Cases are often notoriously difficult to treat and manage owing to associated comorbidities of the patient, post irradiation fibrosis and decreased vascularity at the site, which complicates free tissue flap and graft transfer, that subsequently succumb to failure. Hyperbaric oxygen therapy (HBOT), in which 100 % oxygen is administered by mask under 2.4 atm pressure, in a hyperbaric oxygen chamber, helps by increasing local vascularity. Aim and Methods It was the aim of this study to show that a particularly refractory, compromised and challenging case of osteoradionecrosis can be managed successfully even without HBOT, by mandibular segmental resection followed by reconstruction using a titanium reconstruction plate enveloped within a pedicled Pectoralis Major Myocutaneous flap. Result Post operative recovery of the patient was excellent with good functional and esthetic rehabilitation of the patient with and practically nil donor site morbidity. Conclusion It is important to have a thorough knowledge of the clinical, radiographic, histopathologic, CT and MRI features of osteoradionecrosis of the jaws in order to make a quick and accurate confirmatory diagnosis and to overcome possible diagnostic dilemmas. The strategy of reconstruction of a large mandibular defect using a bridging titanium plate sandwiched by a healthy vascularized myocutaneous flap, following ablative surgery for ORN, has proved to be a safe and reliable option for composite mandibular defects, with gratifying long term functional and cosmetic results.

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“…Although the PMMPF has been widely used in head and neck reconstruction since its first introduction by Ariyan in 1979 [1][2][3][4], many studies have revealed the reliability of free tissue transfer since the 1980s. Therefore, the role of the PMMPF in head and neck reconstruction has been supplanted by free tissue transfer in several situations [3,4,9].…”

Section: Discussionmentioning

confidence: 99%

“…The pectoralis major myocutaneous pedicled flap (PMMPF) is considered the "workhorse" flap for head and neck reconstruction operations after its introduction in 1979 by Ariyan [1][2][3][4]. Despite advancements in microsurgery, this flap continues to be the primary reconstructive choice for several reasons, such as good coverage, readily identifiable and reliable bloody supply, reduced operative time, simple technical aspects, lower patient comorbidity, and proximity to the head and neck region [3,[5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Salvage for pectoralis major myocutaneous flap failure in head and neck reconstruction by microvascular flap

Tang

Lai

et al. 2012

Journal of Plastic Surgery and Hand Surgery

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The pectoralis major myocutaneous pedicled flap (PMMPF) - the "workhorse" for head and neck reconstruction - is associated with a high incidence of complications in certain cases. This study presents free tissue transfer as an alternative salvage technique after PMMPF failure in head and neck reconstruction. It includes seven consecutive patients who underwent free tissue salvage after PMMPF failure in head and neck reconstruction from January 2008 to September 2010 at Kaohsiung Medical University Hospital, Taiwan. Four vertical rectus abdominis myocutaneous (VRAM) flaps were applied for tongue and mouth floor defects, while three anterolateral thigh (ALT) flaps were used for mouth floor, buccal, and cheek defects. All flaps survived uneventfully, and normal oral feeding was achieved without major complications. Free tissue transfer has several advantages and can be successfully employed in head and neck reconstruction, and it is also a reliable salvage procedure after PMMPF failure in such cases.

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Clinical Outcome After Pedicled Segmental Pectoralis Major Island Flaps for Head and Neck Reconstruction

Cited by 23 publications

References 21 publications

Analysis of 120 Pectoralis Major Flaps for Head and Neck Reconstruction

Analysis of 120 Pectoralis Major Flaps for Head and Neck Reconstruction

Diagnostic Features and Management Strategy of a Refractory Case of Osteoradionecrosis of the Mandible: Case Report and Review of Literature

Salvage for pectoralis major myocutaneous flap failure in head and neck reconstruction by microvascular flap

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