Crossed pectoralis major myocutaneous flap for recurrent oral cavity cancers

Abstract

Background:Oral cavity cancers are fairly common and have propensity to recur locally. Since Pectoralis Major Myocutaneous (PMMC) flap is the most widely used first flap for reconstruction, it is exhausted at the earliest and recurrence poses a formidable challenge for reconstructive surgeon. Present study evaluated the feasibility of contralateral Pectoralis Major Myocutaneous Flap for reconstruction after resection of recurrent tumour.Methods:This was a study of the patients presenting with recurrent oral cavity cancer after exhausted ipsilateral Pectoralis Major Myocutaneous Flap (PMMC) in whom we used contralateral Pectoralis Major Myocutaneous Flap (Crossed PMMC Flap) for reconstruction between October 2013 to June 2016.Results:Five patients with recurrence underwent reconstruction with contralateral Pectoralis Major Myocutaneous Flap. In all the flap was successfully used to reconstruct defects involving the entire buccal mucosa and in one patient the flap could be used to reconstruct full thickness resection defect(crossed bipedal PMMC Flap) with ease.Conclusion:Crossed Pectoralis Major Myocutaneous Flap can be used safely and reliably for reconstruction of the buccal mucosal defect and in selected patients even for full thickness cheek defect as folded bipaddle Pectoralis Major Myocutaneous Flap.

Outcomes of Pectoralis Major Myocutaneous Flap in the Reconstruction of Head and Neck

“…In the era of microsurgical free flaps, pedicled flaps still hold their position for the reconstruction of oral cavity cancers [13]. Study conducted by Pancholi M et al have shown PMMC flap to be easy, done early and adds to the bulk of reconstructed tissue thereby maintaining the contour especially in full thickness cheek defects post hemimandibulectomy or maxillectomy where a radial forearm flap will leave a distinct hollow due to lack of bulk [14]. In our study all the patients belonged to advanced stages of the disease, requiring marginal /hemimandibulectomy hence resulting in larger cavities all were treated with PMMC flaps and have given good results.…”

Approach to Reconstruction of Cheek Defects

“…For full-thickness defects, the buccal mucosa should be corrected; commonly used regional flaps for buccal mucosal involvement include the pectoralis major myocutaneous (PMMC) flap, submental island flap, forehead flap, and latissimus dorsi flap. 13 However, forehead flaps call for a multistaged procedure that results in appreciable donor-site morbidity, whereas latissimus dorsi flaps require a change of position of the patient during the operation. 13 Therefore, only the PMMC and submental island flap are discussed herein.…”

“…13 However, forehead flaps call for a multistaged procedure that results in appreciable donor-site morbidity, whereas latissimus dorsi flaps require a change of position of the patient during the operation. 13 Therefore, only the PMMC and submental island flap are discussed herein.…”

“…Widely used as a preliminary procedure, the ipsilateral PMMC flap is exhausted at an early stage during the repair of full-thickness cheek defects. 13 Unfortunately, oral cavity cancers have a high recurrence rate, requiring a secondline option. 13 Pancholi et al 13 report a similar repair capacity for contralateral PMMC flaps as the ipsilateral variant for the repair of both mucosal and full-thickness defects.…”

“…13 Unfortunately, oral cavity cancers have a high recurrence rate, requiring a secondline option. 13 Pancholi et al 13 report a similar repair capacity for contralateral PMMC flaps as the ipsilateral variant for the repair of both mucosal and full-thickness defects. Like the ipsilateral flap, the contralateral flap is transposed through a subcutaneous tunnel and folded over itself.…”