Does Pectoralis Major Myocutaneous Flap Cause the Shoulder Morbidity: A Clinical Comparative Study

Abstract

The aim was to compare the morbidity of shoulder function following modified radical neck dissection with and without Pectoralis Major Myocutaneous muscle flap (PMMC) harvest in head and neck cancer patient to determine the effect of PMMC flap harvest on shoulder function and also to determine the effect of physiotherapy. Materials and methods: Prospective study involving two groups study group of 20 patients with MRND, with PMMC flap reconstruction as part of head and neck cancer surgery and control group of 20 patients who had undergone MRND(IJV & SAN sparing) without PMMC flap in same period were included. All patients were assessed at 3rd and 6th month following completion of surgery using subjective (Shoulder Disability Questionnaire) and objective (goniometer and manual muscle testing) parameters. 40 patients were included in the study, 33 (82.5%) male and 7 (17.5%) female with a mean age of 49 years with stage III/IV carcinoma In Group-1 and Group-2 the shoulder disability decreased significantly after physiotherapy intervention and also at 6thmonth postoperatively both groups showed improvements in shoulder range of motion and muscle strength. Harvesting of PMMC flap does not intensify the morbidity of shoulder which is common in RND and during MRND. A regimen of home-based exercises and patient education are effective tools to reduce shoulder disability and improving shoulder function.

Reconstruction for Salvage Laryngectomy With Limited Pharyngectomy

“…From the standpoint of donor-site morbidity, FTT has a minimal impact in long-term function, 24 which contrasts to the shoulder and arm morbidity associated with pectoralis muscle flaps. 25,26 However, FTT requires a higher acuity of care as well as additional equipment and expertise that may result in higher costs. 27 Interestingly, a recent study found this technique to be cost-effective compared with locoregional flaps, even in patients with localized head and neck cancer.…”

“…From the standpoint of donor-site morbidity, FTT has a minimal impact in long-term function, which contrasts to the shoulder and arm morbidity associated with pectoralis muscle flaps . However, FTT requires a higher acuity of care as well as additional equipment and expertise that may result in higher costs .…”