Use of Pectoralis Major Myocutaneous Flap for Marginal Mandibulectomy Defects of Oral Cavity Cancers - A 5 Year Institutional Experience.

Abstract

Segmental resections of the mandible may cause severe functional and aesthetic problems due to continuity loss. The morbidity after mandibular resection can be minimized after microvascular transfer of vascularized bone grafts. Although free flaps have become the gold standard in the past decades for reconstruction of oral cavity defects, regional flaps can also be a reliable option in certain cases, especially for those belonging to the lower socioeconomic corridor and or with coexisting chronic comorbidities which will not allow lengthier procedures. (Milenović A, Virag M, Uglešić V, Aljinović-Ratković N (2006) The pectoralis major flap in head and neck reconstruction: first 500 patients. J Cranio-Maxillofacial Surg 34(6):340-343); (Sabri A (2003) Oropharyngeal reconstruction: current state of the art. Current opinion in otolaryngology & head and neck surgery. 11(4):251-254); (Porcuna DV, Vintró XL, Vilas ML, Olmo AP, Ayala JM, Agustí MQ (2008) Pectoralis major flaps. Evolution of their use in the age of microvascularized flaps. Acta Otorrinolaringologica (English Edition) 59(6):263-268) There are a very few reports of early oral cancers being reconstructed by PMMC flap. In this article, however, we have exclusively reviewed 247 cases of early oral cancer requiring marginal mandibulectomy and their reconstruction with PMMC flap thus justifying the name, the "workhorse flap" even in early oral cancers. This is a retrospective analysis of 5-year patient data collected from our institutional data register of 247 patients undergoing marginal mandibulectomy and reconstruction with PMMC flap between April 2017 to June 2022. No flap loss was reported. No cases were re-explored either for hematoma or for congestion. All patients recovered uneventfully. Although, in this era, free flaps dominate in the soft tissue reconstruction and PMMC is used only in certain advanced oral cancers, our study proves that it can be used safely in effectively in early oral cancer patients as well. Being a quicker procedure, PMMC flap reconstruction should be considered as a valid alternative in early oral cancers requiring marginal mandibulectomy, to overcome the increasing oral malignancy patient load belonging to low socioeconomic regions. To the best of our knowledge, this is the largest data ever published.