Outcomes of the pectoralis major muscle flap for covering a mandibular reconstruction plate: Our experience at the Leiden University Medical Center.

BACKGROUND

Free vascularized fibula reconstruction is the gold standard for oromandibular defect reconstruction following tumor ablative surgery. However, in patients with poor prognosis, compromised general health, or inadequate vascular status in the lower extremities or chest, less invasive alternatives may be preferable. This study evaluated outcomes and complication rates of mandibular defect reconstruction using a reconstruction plate covered with a pedicled pectoralis major muscle flap (PMMF), performed after tumor ablation or for osteoradionecrosis.

METHODS

A retrospective review was conducted of twenty-one patients who underwent PMMF coverage of a mandibular reconstruction plate following oral cavity cancer resection or for osteoradionecrosis at the Leiden University Medical Center (LUMC) between April 2011 and August 2023. Primary outcomes included plate exposure, wound dehiscence, and flap vitality.

RESULTS

Twenty-one patients (eleven men, ten women) were included, with a median follow-up of 20.5 months (range 1.6 months to 2.4 years). Plate exposure occurred in eleven patients (52.4%) after a median of 2.7 weeks; six required plate removal. Two patients underwent successful re-coverage without removal, and three were managed expectantly. Wound dehiscence occurred in eighteen patients (85.7%), and partial flap necrosis in eight (38.1%).

CONCLUSION

Mandibular reconstruction using a plate covered with a PMMF is associated with high complication rates, particularly plate exposure, frequently necessitating reoperation and adversely affecting quality of life. These findings question the suitability of this approach in patients who are not candidates for free fibula reconstruction. Although high complication rates of soft tissue coverage over reconstruction plates are well documented, our results underscore the need to refine patient selection, optimize plate characteristics, improve surgical technique, and consider alternative strategies, including PMMF reconstruction without plate placement.