Using a pedicle pectoralis major musculocutaneous flap in head and neck reconstruction after modified radical mastectomy

Abstract

Rationale:A pedicle pectoralis major musculocutaneous (PMMC) flap is one of the strategies for head and neck reconstruction. Seldom studies reported the case in which the skin area of previous modified radical mastectomy (MRM) had been used as a PMMC flap in head and neck reconstruction.Patient concerns:An 84-year-old female who had suffered from left breast cancer and undergone a left modified radical mastectomy (MRM) more than 20 years earlier.Diagnoses:She had squamous cell carcinoma of the tongue and had undergone partial glossection and left modified radial neck dissection. Four months later, a left submandibular mass was noted with progressive enlargement and the biopsy revealed recurrent carcinoma.Interventions:Left marginal mandibulectomy with radical neck dissection was performed and the neck area was reconstructed by a left pedicle PMMC flap harvested from the left chest wall which had the previous MRM scar.Outcomes:The post-operative course was uneventful with complete survival of the flap. The patient received post-operative adjuvant radiotherapy at the left neck and no delayed wound disruption or flap necrosis was noted six months after surgery.Lessons:A pedicle PMMC flap may be harvested to achieve a functionally as well as an aesthetically pleasing outcome without compromising its viability despite the previous MRM.

Pectoralis Major Flap Interest in Maxillofacial Reconstruction About A Case

“…The pectoralis major muscle flap was first described by Pickrell in 1947 as a turnover flap in chest wall reconstruction [1] but the pedicle pectoralis major myocutaneous (PMMC) flap based on the thoracoacromial artery procedure was originally developed by Dr Ariyan in 1979 and has been widely used in the reconstruction of head and neck defects [2][3][4][5].On human anatomy the pectoralis major has a clavicular head, a sternocostal head, and an abdominal portion [1,6]. It was shown that the skin obtains its blood supply through the underlying muscle [7].…”

“…In general, the pectoralis major myofascial (PMMF) and PMMC, are by far the most employed techniques [2]. The PMMF is consisting in the use of pectoralis major muscle alone with overlying fascia without the skin paddle [4]. While PMMC is more suitable for reconstruction involving skin defects, the PMMF variant better complies with mucosal defects [2].…”

“…While PMMC is more suitable for reconstruction involving skin defects, the PMMF variant better complies with mucosal defects [2]. This is a commonly used flap in reconstructive head and neck surgery [4,8] but in literature a few case of oral reconstruction is reported. In our case the patient, with oro-labial squamous cell carcinoma was treated by tumor ablation and neck dissection with the need of primary reconstruction.…”

“…Mehrhof et al reported a complication rate of 54% with major complications were total flap necrosis (4-7%) and partial flap necrosis (12-27%). The vast majority were minor complications that didn't require second procedures for correction: orocutaneous fistulas (16, 5%), suture line dehiscence (12%), neck wound complications (11%), donor sire complication (1, 3%) [2,4]. In addition post-operative care, patient was instructed to limit range of motion exercises to minimize harvested muscle movement.…”

Rekonstruksi Pectoralis Major Myocutaneuos Flap untuk Defek Operasi Kanker Tiroid

“…Selain itu, dibandingkan free flap prosedur ini lebih singkat dan tidak memerlukan pemantauan intensif post operasi. 10 Kelemahan pectoralis major myocutaneous flap adalah kemungkinan sirkulasi darah tidak konsisten yang dapat menyebabkan nekrosis flap sebagian atau total. Nekrosis kulit merupakan komplikasi yang banyak ditemukan; angka kejadian nekrosis kulit antara 7% sampai 27%.…”