Comparison between anterolateral thigh perforator free flaps and pectoralis major pedicled flap for reconstruction in oral cancer patients-A quality of life analysis

Yan, Xuemin; Zhu, Juanfang; Cai, Xiangping; Wang, Jing; Liu, Fei; Wang, Haibin

doi:10.4317/medoral.19276

Cited by 28 publications

(31 citation statements)

References 19 publications

(24 reference statements)

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“…Although the pectoralis major muscle is the main muscle of the anterior chest wall, it is not considered necessary for basic movements in everyday life [ 28 ]. However, previous work has reported impaired shoulder mobility after PMMF, without describing the technique of muscle harvest in detail [ 10 , 11 , 29 , 30 ]. This suggests that the conventional harvesting technique was applied, possibly resulting in larger muscle defects and thereby functional drawbacks.…”

Section: Discussionmentioning

confidence: 99%

“…Limitations of the PMMF include donor site morbidity in terms of aesthetic and functional outcome, as the conventional harvesting technique includes detachment of the entire muscle and leaves the patient with extensive scarring across the chest. Studies suggest impaired shoulder mobility after harvesting the PMMF as the pectoralis major muscle is the main muscle of the anterior chest wall [ 10 , 11 , 12 , 13 ]. We previously described a modified muscle-sparing harvesting method preserving the clavicular and upper sternocostal part of the pectoralis major muscle that is routinely applied at our hospital [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Functional Shoulder Outcome and Quality of Life Following Modified Muscle-Sparing Pectoralis Major Flap Surgery

et al. 2021

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Background: The pedicled pectoralis major muscle flap (PMMF) is a well established flap for fistula prophylaxis after salvage laryngectomy. To reduce donor site morbidity, we established a modified muscle-sparing harvesting technique. We herein investigate postoperative shoulder function and health-related quality of life (HRQOL). Methods: A chart review of patients receiving the modified muscle-sparing pectoralis major muscle flap between 2013–2020 was performed. Nineteen patients (male = 18, female = 1) were potentially eligible and six male patients were ultimately enrolled. Postoperative shoulder function was assessed on both sides (flap side versus non-flap side) using the Constant Murley Score and the Bak criteria. Health-related quality of life was assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire in cancer patients (EORTC QLQ-C30) and head and neck cancer patients (EORTC H&N35). Results: No Constant Murley Score subscale was statistically significant (p ≥ 0.180). Bak criteria was overall rated “Good“. Solely upper extremity adduction force was significantly altered on the flap side (p = 0.039). Median EORTC QLQ-C30 score was 82.2 (IQR 11.1) on the functional scale and 10.3 (IQR 2.6) on the symptomatic scale. Median quality of life score was 75.0 (IQR 33.3) and median EORTC QLQ-H&N35 was 20.6 (IQR 9.8). Conclusions: Postoperative shoulder function after modified muscle-sparing pectoralis major muscle flap surgery is comparable to function of the healthy side with a significant deficiency in adduction force not compromising daily life in this small study cohort.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Functional Shoulder Outcome and Quality of Life Following Modified Muscle-Sparing Pectoralis Major Flap Surgery

et al. 2021

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“…These patients often face speech, eating and respiration impairments in combination with facial disfigurement. Therefore, along with survival as a key measure of success in the treatment of patients with oral cancer, health-related QOL has been increasingly recognized as an important tool to be considered in the assessment of treatment outcomes [11] . It provides information about the perceptions of patients.…”

Section: Discussionmentioning

confidence: 99%

“…They facilitate multidisciplinary team working with the recognition of poor outcome groups, provide better information for the patient and their care givers, and allow the opportunity to identify problem areas and target intervention [4] . It arms the clinician with useful information and can contribute to decision making based on patient feedback [11] .…”

Section: Discussionmentioning

confidence: 99%

Assessment of quality of life after arch preserving segmental mandibulectomy in patients reconstructed with PMMC or free fibula flap

Aslam¹,

Shahana²

2020

Int. J. Surg. Sci.

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The aim of our study was to evaluate by questionnaire the HRQOL who have had mandibular resection of oral cancers and reconstruction with either free fibular flap or PMMC. Settings and Design: Retrospective study Methods and Material: The study was done in a tertiary care hospital over a period of 2years. Adult and consenting patients who had underwent lateral segmental mandibulectomy with successful reconstruction were included. Statistical analysis: Information from the data was correlated against the socio-demographic and treatment variables using the Mann Whitney U test. Data were recorded and then analysed & P<0.05 were accepted as significant. Results: Of total 60 patients, Quality of life UW-QOL scores for 12 disease-specific domains show no significant differences between the average scores of the two groups for the shoulder, taste, saliva, mood and anxiety domains. However, there were significant differences between the Free fibula graft and PMMF and groups for the pain, appearance, activity, recreation, swallowing, chewing and speech domains. Conclusions: The composite QOL score and global QOL were more in patients with free fibula graft compared to patients who received PMMC implying better overall results with free fibula graft. Therefore, we emphasize that free fibula flap remains the preferred option for reconstruction of segmental defects in patients undergoing arch preserving mandibulectomy.

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“…When compared with the PMMF, the anterolateral thigh (ALT) flap (with or without muscle) has a lower donor site morbidity; greater reach (depending on the availability of target vessels for microvascular anastomosis), and more degrees of freedom at flap inset, which offers the potential to inset under less tension, when compared with regional flaps. Free flaps in general may result in shorter hospital stays and better functional outcomes in head and neck defects elsewhere . Free flaps have an overall flap survival in head and neck reconstruction of between 96% and 98% and a low incidence of perioperative complications .…”

Section: Introductionmentioning

confidence: 99%

Anterolateral thigh versus pectoralis major flaps in reconstruction of the lateral temporal bone defect

Parr

Chouhan

Wagels

2018

ANZ Journal of Surgery

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Background: Free tissue reconstruction is reliable in suitable patients but patient selection remains a challenge for the reconstructive surgeon. The anterolateral thigh (ALT) free flap and pedicled pectoralis major myocutaneous flap (PMMF) are two common reconstructive options for a lateral temporal bone resection defect. The threshold at which free tissue reconstruction should be considered over locoregional reconstruction is not defined. We sought to define reconstructive flap choice in the setting of medical comorbidities that may dissuade free tissue transfer. Methods: A retrospective analysis of lateral temporal bone defects at a single institution was undertaken. The primary outcomes were flap survival, surgical complications and durations of surgery and stay. Data regarding medical comorbidities and potential confounders were examined. Results: Sixty patients with lateral temporal bone defects were identified. Twenty-four (40%) patients underwent PMMF reconstruction and 36 (60%) were reconstructed with ALT. The former were significantly older (73 versus 62 years), though with similar Anesthesiologists Risk Classification System status. Free-flap reconstruction resulted in significantly less flap loss (two versus six) but a longer operating time (790 versus 671 min). Conclusion: Patients suffering head and neck cancer with medical comorbidities can make selection of a suitable reconstruction difficult. We found that while patients undergoing ALT reconstruction were typically younger, the comorbidity profile of those patients was similar to patients undergoing PMMF reconstruction. ALT flaps were more reliable than the PMMF, lending credence to the view that free tissue transfer should be the preferred reconstructive option in suitable candidates and defects. © 2018 Royal Australasian College of Surgeons ANZ J Surg 89 (2019) E132-E136 ANZJSurg.com © 2018 Royal Australasian College of Surgeons E134Parr et al.

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Comparison between anterolateral thigh perforator free flaps and pectoralis major pedicled flap for reconstruction in oral cancer patients-A quality of life analysis

Cited by 28 publications

References 19 publications

Functional Shoulder Outcome and Quality of Life Following Modified Muscle-Sparing Pectoralis Major Flap Surgery

Functional Shoulder Outcome and Quality of Life Following Modified Muscle-Sparing Pectoralis Major Flap Surgery

Assessment of quality of life after arch preserving segmental mandibulectomy in patients reconstructed with PMMC or free fibula flap

Anterolateral thigh versus pectoralis major flaps in reconstruction of the lateral temporal bone defect

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