Resection and reconstruction of giant cervical metastatic cancer using a pectoralis major muscular flap transfer: A prospective study of 16 patients

Abstract

Abstract.If not promptly or properly treated, certain cervical metastatic cancers that develop from unknown primary tumors may rapidly grow into giant tumors that can invade the blood vessels, muscle and skin. The present study examined the feasibility and efficacy of radical neck dissection combined with reconstruction using the pectoralis major myocutaneous flap for the treatment of giant cervical metastatic cancers that have developed from unknown primary tumors and have invaded the skin. A total of 16 patients who met the inclusion criteria were subjected to radical neck dissection to adequately resect invaded skin, and the pectoralis major myocutaneous flap was used to repair the large skin defect created in the cervical region. Following the surgery, the patients received concurrent chemoradiotherapy. The pectoralis major myocutaneous flap survived in all 16 patients, with no cases of flap necrosis. In addition, no post-operative lymphedema, paresthesia or dysfunction of an upper extremity occurred due to the cutting of a pectoralis major muscle. In 9 cases, patients were satisfied with their post-operative shoulder movement at the donor site; in the remaining 7 cases, patients felt greater weakness in this region following surgery relative to prior to surgery. The 14 male patients were generally satisfied with the post-operative appearance of the donor region, whereas the 2 female patients were dissatisfied with the appearance of this region. Follow-up for 6-53 months after the patients were discharged following surgery and chemotherapy revealed that the recurrence of cervical tumors in 6 cases. Overall, radical neck dissection combined with the use of the pectoralis major myocutaneous flap for reconstruction is a feasible approach for the treatment of giant cervical metastatic cancers that have developed from unknown primary tumors and have invaded the skin. Post-operative concurrent chemoradiotherapy should be administered to improve the local control rate and patient quality of life, allowing a satisfactory therapeutic efficacy to be achieved.

Coverage of complex defects of the shoulder girdle and posterior neck triangle following tumor resection

“…Our approach (mentioned in the introduction) is demonstrated in the case reports and utilizes only two pedicle muscle flaps: the latissimus dorsi and pectoralis major muscles. Although there are many different flaps around the shoulder girdle that could be utilized for reconstruction [1] , [2] , [3] , [4] , [5] , [6] , we prefer these two muscles because they are large (defects created post tumor resection are generally large in size) and reliable. Furthermore, the donor site morbidities for these two muscles are known to be minimal [10] , [11] .…”

“…Numerous pedicle and free flaps have been used to cover complex defects of the shoulder girdle and posterior neck triangle following tumor resection [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] . However, the literature does not offer any choices of flap selection in these cases.…”

Reoperation following the use of non‑standardized procedures for malignant parotid tumors

“…The pectoralis major muscle flap comprises a large bulk of tissue that may completely repair neck tissue defects following neck dissection and cover skin defects of the parotid region (44). The pectoralis major muscle flap also has a rich blood supply, which leads to strong resistance to infection and necrosis, as well as allowing for fast healing; its application may prevent neck vascular exposure, which has been observed following necrosis of other types of flap, and will therefore not delay radiotherapy following surgery (14,15). In addition, the use of the pectoralis major muscle flap allows for more natural wound appearance following surgery, and the cosmetic appearance is improved compared to those using the submental island flap (45).…”