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

Akira Saito, Hidehiko Minakawa, Noriko Saito, Tatsumi Nagahashi

Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
Division of Head and Neck Surgery, Hokkaido Cancer Center, Sapporo, Japan.
Division of Plastic and Reconstructive Surgery, Hokkaido Cancer Center, Sapporo, Japan.

DOI: 10.4236/mps.2012.24025                

Abstract

The pectoralis major musculocutaneous (PMMC) flap has been a useful technique for head and neck reconstruction since its first description by Ariyan in 1979. However, techniques in microvascular surgery have since evolved and recently free tissue transfer has played an important role in head and neck reconstruction. Although we use free flaps as the first choice for head and neck reconstruction, similar to many other institutions, some patients at our hospital have undergone reconstruction with PMMC flaps. We retrospectively analyzed the indications and outcomes of this reconstructive technique from our experience with 12 patients. The medical records of all patients who underwent PMMC flaps at Hokkaido Cancer Center from 2001 to 2010 were reviewed. Data concerning diagnosis, main indication, site of reconstruction, previous treatment, and postoperative complications were analyzed. Of the 12 PMMC flap surgeries performed, 3 were carried out as primary reconstructive procedures, whereas 9 were done as “salvage” procedures. Flap-related complications were observed in 6 cases. Partial flap loss developed in 4 patients, although there were no cases of total flap loss. There were 3 recurrent fistulae following reconstruction with PMMC flaps. The preoperative goals of performing PMMC flap surgery were met in 83% of our cases. The authors conclude that while free flap transfer is usually the first choice for head and neck reconstruction, PMMC flaps can produce acceptable results in certain situations.

Keywords

Pectoralis Major Myocutaneous Flap; Head and Neck Reconstruction; Pedicled Flap; Pedicled Pectoralis Major Myocutaneous Flap; Reconstruction, Microsurgery

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	S. Ariyan, “The Pectoralis Major Myocutaneous Flap. A Versatile Flap for Reconstruction in the Head and Neck,” Plastic and Reconstructive Surgery, Vol. 63, No. 1, 1979, pp. 73-81. doi:10.1097/00006534-197901000-00012
[2]	I. J. CB, S. E. Hovius, B. L. ten Have, S. J. Wijthoff, G. J. Sonneveld, C. A. Meeuwis and P. P. Knegt, “Is the Pectoralis Myocutaneous Flap in Intraoral and Oropharyngeal Reconstruction Outdated?” The American Journal of Surgery, Vol. 172, No. 3, 1996, pp. 259-262. doi:10.1016/S0002-9610(96)00161-4
[3]	S. Mehta, S. Sarkar, N. Kavarana, H. Bhathena and A. Mehta, “Complications of the Pectoralis Major Myocutaneous Flap in the Oral Cavity: A Prospective Evaluation of 220 Cases,” Plastic and Reconstructive Surgery, Vol. 98, No. 1, 1996, pp. 31-37. doi:10.1097/00006534-199607000-00006
[4]	R. Liu, P. Gullane, D. Brown and J. Irish, “Pectoralis major Myocutaneous Pedicled Flap in Head and Neck Reconstruction: Retrospective Review of Indications and Results in 244 Consecutive Cases at the Toronto General Hospital,” Journal of Otolaryngology, Vol. 30, No. 1, 2001, pp. 34-40. doi:10.2310/7070.2001.21011
[5]	J. G. Vartanian, A. L. Carvalho, S. M. Carvalho, L. Mizobe, J. Magrin and L. P. Kowalski, “Pectoralis Major and Other Myofascial/Myocutaneous Flaps in Head and Neck Cancer Reconstruction: Experience with 437 Cases at a Single Institution,” Head & Neck, Vol. 26, No. 12, 2004, pp. 1018-1023. doi:10.1002/hed.20101
[6]	A. L. McCrory and J. S. Magnuson, “Free Tissue Transfer versus Pedicled Flap in Head and Neck Reconstruction.” Laryngoscope, Vol. 112, No. 12, 2002, pp. 2161-2165. doi:10.1097/00005537-200212000-00006
[7]	K. E. Blackwell, D. Buchbinder, H. F. Biller and M. L. Urken, “Reconstruction of Massive Defects in the Head and Neck: The Role of Simultaneous Distant and Regional Flaps,” Head & Neck, Vol. 19, No. 7, 1997, pp. 620-628. doi:10.1002/(SICI)1097-0347(199710)19:7<620::AID-HED10>3.0.CO;2-6
[8]	C. Y. Hsing, Y. K. Wong, C. P. Wang, C. C. Wang, R. S. Jiang, F. J. Chen and S. A. Liu, “Comparison between Free Flap and Pectoralis Major Pedicled Flap for Reconstruction in Oral Cavity Cancer Patients—A Quality of Life Analysis,” Oral Oncology, Vol. 47, No. 6, 2011, pp. 522-527. doi:10.1016/j.oraloncology.2011.03.024
[9]	D. B. Chepeha, G. Annich, M. A. Pynnonen, J. Beck, G. T. Wolf, T. N. Teknos, C. R. Bradford, W. R. Carroll and R. M. Esclamado, “Pectoralis Major Myocutaneous Flap vs Revascularized Free Tissue Transfer: Complications, Gastrostomy Tube Dependence, and Hospitalization,” Archives of Otolaryngology—Head & Neck Surgery, Vol. 130, No. 2, 2004, pp. 181-186. doi:10.1001/archotol.130.2.181
[10]	D. Novakovic, R. S. Patel, D. P. Goldstein and P. J. Gullane, “Salvage of Failed Free Flaps Used in Head and Neck Reconstruction,” Head & Neck Oncology, Vol. 1, 2009, p. 33. doi:10.1186/1758-3284-1-33
[11]	A. Talesnik, B. Markowitz, T. Calcaterra, C. Ahn and W. Shaw, “Cost and Outcome of Osteocutaneous Free-Tissue Transfer versus Pedicled Soft-Tissue Reconstruction for Composite Mandibular Defects,” Plastic and Reconstructive Surgery, Vol. 97, No. 6, 1996, pp. 1167-1178. doi:10.1097/00006534-199605000-00011
[12]	H. H. El-Marakby, “The Reliability of Pectoralis Major Myocutaneous Flap in Head and Neck Reconstruction,” Journal of Egyptian National Cancer Institute, Vol. 18, No. 1, 2006, pp. 41-50.
[13]	J. N. McLean, G. W. Carlson and A. Losken, “The Pectoralis Major Myocutaneous Flap Revisited: A Reliable Technique for Head and Neck Reconstruction,” Annals of Plastic Surgery, Vol. 64, No. 5, 2010, pp. 570-573.
[14]	D. S. Schneider, V. Wu and M. K. Wax, “Indications for Pedicled Pectoralis Major Flap in a Free Tissue Transfer Practice,” Head & Neck, Vol. 34, No. 8, 2012, pp. 1106-1110. doi:10.1002/hed.21868
[15]	F. R. Pinto, C. R. Malena, C. M. Vanni, A. Capelli Fde, L. L. Matos and J. L. Kanda, “Pectoralis Major Myocutaneous Flaps for Head and Neck Reconstruction: Factors Influencing Occurrences of Complications and the Final Outcome,” Sao Paulo Medical Journal, Vol. 128, No. 6, 2010, pp. 336-341. doi:10.1590/S1516-31802010000600005
[16]	R. I. Zbar, G. F. Funk, T. M. McCulloch, S. M. Graham and H. T. Hoffman, “Pectoralis Major Myofascial Flap: A Valuable Tool in Contemporary Head and Neck Reconstruction,” Head & Neck, Vol. 19, No. 5, 1997, pp. 412-418. doi:10.1002/(SICI)1097-0347(199708)19:5<412::AID-HED8>3.0.CO;2-2
[17]	M. L. Shindo, P. D. Costantino, C. D. Friedman, H. J. Pelzer, G. A. Sisson, Sr. and F. J. Bressler, “The Pectoralis Major Myofascial Flap for Intraoral and Pharyngeal Reconstruction,” Archives of Otolaryngology—Head & Neck Surgery, Vol. 118, No. 7, 1992, pp. 707-711. doi:10.1001/archotol.1992.01880070037007
[18]	J. P. Shah, V. Haribhakti, T. R. Loree and P. Sutaria, “Complications of the Pectoralis Major Myocutaneous Flap in Head and Neck Reconstruction,” The American Journal of Surgery, Vol. 160, No. 4, 1990, pp. 352-355. doi:10.1016/S0002-9610(05)80541-0
[19]	P. D. Righi, E. C. Weisberger, S. R. Slakes, J. L. Wilson, K. A. Kesler and P. B. Yaw, “The Pectoralis Major Myofascial Flap: Clinical Applications in Head and Neck Reconstruction,” American Journal of Otolaryngology, Vol. 19, No. 2, 1998, pp. 96-101. doi:10.1016/S0196-0709(98)90102-8