[Reconstruction with pectoralis major myocutaneous flap for surgical defect in advanced head and neck cancer patients].

BACKGROUND &

OBJECTIVE

Total or partial defects after one-stage reconstruction for advanced head and neck cancer is a challenging problem in head and neck surgery. Pectoralis major myocutaneous flap (PMMF) plays an irreplaceable role in head and neck reconstruction surgery. This study was to define operational indications for using PMMF in head and neck defect reconstruction, and summarize how to further increase the success rate.

METHODS

From Jan. 2004 to Jan. 2007, 22 patients who underwent head and neck defect reconstruction using PMMF were investigated. Of the 22 patients, 8 had cervical skin defect, 5 had tongue defect, 4 had oropharynx defect, 3 had base of tongue defect, and 2 had hypopharynx defect; 13 had the flap passed through the subclavicular tunnel to the head and neck area, and 9 had the flap transposed over clavicle to the neck. The reconstruction size ranged from 15 cm x 12 cm to 8 cm x 5 cm.

RESULTS

No patient died during operation, 1 had total flap necrosis, and 1 had partial flap necrosis. The success rate of reconstruction was 95.5%. Postoperative complications occurred in 2 (9.1%) patients: 1 had wound hematocele, and 1 had fistula at the base of the tongue.

CONCLUSIONS

PMMF is a good donor for head and neck reconstruction, especially for resurfacing huge cervical skin defect. The approach of passing the vascular pedicle through a subclavicular tunnel will not only enhance the arc of rotation, but also help to prevent compression of the vascular pedicle.