Indications and Outcomes for Pedicled Pectoralis Major Myocutaneous Flaps at a Primary Microvascular Head and Neck Reconstructive Center

Abstract

The pectoralis major musculocutaneous (PMMC) flap has been a useful technique for head and neck reconstruction since its first description by Ariyan in 1979. However, techniques in microvascular surgery have since evolved and recently free tissue transfer has played an important role in head and neck reconstruction. Although we use free flaps as the first choice for head and neck reconstruction, similar to many other institutions, some patients at our hospital have undergone reconstruction with PMMC flaps. We retrospectively analyzed the indications and outcomes of this reconstructive technique from our experience with 12 patients. The medical records of all patients who underwent PMMC flaps at Hokkaido Cancer Center from 2001 to 2010 were reviewed. Data concerning diagnosis, main indication, site of reconstruction, previous treatment, and postoperative complications were analyzed. Of the 12 PMMC flap surgeries performed, 3 were carried out as primary reconstructive procedures, whereas 9 were done as "salvage" procedures. Flap-related complications were observed in 6 cases. Partial flap loss developed in 4 patients, although there were no cases of total flap loss. There were 3 recurrent fistulae following reconstruction with PMMC flaps. The preoperative goals of performing PMMC flap surgery were met in 83% of our cases. The authors conclude that while free flap transfer is usually the first choice for head and neck reconstruction, PMMC flaps can produce acceptable results in certain situations.

Reliability of the pectoralis major myocutaneous flap in reconstructive oral cancer surgery in developing countries: Our experience

“…Total microvascular flap loss may be seen even in the hands of skilled surgeons, but total PMMC flap failure is very rare even under inexperienced hands, due to its dependable vascularity and its shorter procedural learning curve. 8 The drawbacks of PMMC flap are its higher complication rates; large bulk which contraindicates its use for reconstruction in superficial defects and less than satisfactory functional and esthetic result as compared to free flaps. 6 In addition, there may be resultant malocclusion due to the weight of the flap.…”

“…6 In addition, there may be resultant malocclusion due to the weight of the flap. A review of relevant literature 4,6,[8][9][10][11][12][13][14][15] (Table 3) shows that the overall complication rates vary from low (4.7%) to very high (60%); however, total necrosis of PMMC flap is low in most of the studies. Several studies on PMMC flap have also correlated higher complication with age, sex, site of reconstruction, previous therapy, etc.…”

Evaluation of pectoralis major myocutaneous flap at tertiary care hospital: retrospective study of 60 cases

“…Pectoralis major myocutaneous flap (PMMC) flaps, however, are kept reserved for salvage procedure in case of failure of free flaps, compromised patient status, or if planned as soft tissue filler in combination with free flaps. 3,4 Reconstruction with free flaps in developing country is difficult due to high cost, much time, poor infrastructure, advanced learning curve and scarcity of plastic surgeons. The pedicle flaps can be a deltopectoral flap (fasciocutaneous flap) or a myocutaneous flap that includes pectoralis major, latissimus dorsi, trapezius flaps.…”

Oral Cancer and Reconstruction: A Case Report

“…There are various pedicle regional flaps that have been advocated such as PMMC flap, deltopectoral flap, forehead flap [7]. Recently, the free tissue transfer is being practiced in several centers and are therefore considered as first choice for head and neck reconstruction because of the availability of micro vascular surgeon in many centers although, for all the patients, the free flap transfer cannot be used at every institute since it requires special techniques and equipment's for microsurgery [8,9]. Stephen Ariyan in 1979 described about the pectoralis major myocutaneous (PMMC) flap.…”