Pectoralis major myocutaneous flaps for head and neck reconstruction: factors influencing occurrences of complications and the final outcome

Abstract

CONTEXT AND OBJECTIVE: Pedicled flaps play an important role in cancer treatment centers, particularly in developing and emerging countries. The aim of this study was to identify factors that may cause complications and influence the final result from reconstructions using pectoralis major myocutaneous flaps (PMMFs) for head and neck defect repair following cancer resection. DESIGN AND SETTING:Cross-sectional study at the Hospital de Ensino Padre Anchieta of Faculdade de Medicina do ABC (FMABC). METHODS:Data on 58 patients who underwent head and neck defect reconstruction using PMMFs were reviewed. The final result from the reconstruction (success or failure) and the complications observed were evaluated in relation to the patients' ages, area reconstructed, disease stage, previous oncological treatment and need for blood transfusion.RESULTS: There were no total flap losses. The reconstruction success rate was 93.1%. Flap-related complications occurred in 43.1% of the cases, and half of them were considered major. Most of the complications were successfully treated. Defects originating in the hypopharynx were correlated with the development of major complications (P = 0.02) and with reconstruction failure (P < 0.001). Previous oncological treatment negatively influenced the reconstruction success (P = 0.04). CONCLUSIONS:Since the risk factors for developing major complications and reconstruction failure are known, it is important to heed the technical details and provide careful clinical support for patients in a more critical condition, so that better results from using PMMFs can be obtained.RESUMO CONTEXTO E OBJETIVO: Retalhos pediculados têm grande importância nos centros de tratamento do câncer, principalmente em países emergentes e em desenvolvimento. O objetivo deste trabalho foi identificar fatores que determinam complicações e influenciam no resultado final das reconstruções com retalho miocutâneo de peitoral maior (RMPM) no reparo de defeitos cirúrgicos por ressecções de cânceres de cabeça e pescoço. TIPO DE ESTUDO E LOCAL: Estudo transversal no Hospital de Ensino Padre Anchieta da Faculdade de Medicina do ABC.MÉTODOS: Dados de 58 pacientes submetidos a reconstruções de defeitos de cabeça e pescoço com RMPM foram revisados. O resultado final da reconstrução (sucesso ou falha) e as complicações observadas foram avaliados de acordo com a idade do paciente, área reconstruída, estágio da doença, tratamento oncológico prévio e necessidade de transfusão sanguínea.RESULTADOS: Não houve perda total de retalho. A taxa de sucesso da reconstrução foi de 93,1%. Complicações relacionadas ao retalho ocorreram em 43,1% dos casos e 50% delas foram considerados como complicações maiores. A maioria das complicações foi tratada com sucesso. Os defeitos originados da hipofaringe relacionaram-se com o desenvolvimento de complicações maiores (P = 0,02) e falhas na reconstrução (P < 0,001). Tratamento oncológico prévio influenciou negativamente no sucesso da reconstrução (P = 0,04).CONCLUSÕES: Como os fatores de risco...

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

“…In all other patients, reconstructions with primary PMMC flaps were successful, with the reconstruction success rate being 83%. These results are slightly lower than success rates of other studies, which ranged from 87.5% to 100% [13,[15][16][17].…”

“…Previous reports have described the risk factors associated with the development of flap complications, such as age, sex, tumor location, site of reconstruction, prior radiotherapy, and comorbidities, large tumor resections, cigarette packs smoked, and salvage procedures [3,15,18,19]. However, results were not similar in all series with some reports describing that complication rates were not associated with age, sex, smoking, preoperative radiotherapy, diabetes, or obesity [2,4,5,12].…”

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

“…The criteria of Pinto et al 4 and Chepeha et al 7 were followed for documentation of complications. The complications at recipient and donor sites, directly related to the PMMC flap were categorized as 'flap-related complications' and other complications not directly related to the PMMC reconstruction were regarded as 'other complication'.…”

“…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.…”

“…2 In contrast, pectoralis major myocutaneous (PMMC) flap is still considered as the 'work horse of pedicled flaps' for headneck reconstruction, since its description by Ariyan in 1979 3 and it still remains popular in developing countries around the globe. 4 The advantages of this flap are excellent vascularity, proximity to head and neck region, simplicity of harvesting, and consequent to their bulk have the main benefit of covering vital structures of neck, unlike free flaps or other regional flaps.…”