Pectoralis Major Myocutaneous Flap Reconstruction in Locally Advanced Head and Neck Malignant Solitary Fibrous Tumors: Functional and Oncologic Outcomes.

Abstract

Background: Malignant solitary fibrous tumor (MSFT), a rare mesenchymal malignancy with aggressive local infiltration and metastatic propensity, poses significant therapeutic challenges in the head and neck region. Locally advanced cases requiring extensive resection necessitate reliable reconstruction strategies to balance oncologic control and functional preservation.

Methods: We conducted a retrospective analysis of 7 consecutive patients with T3/T4N0-2M0 head and neck MSFT undergoing radical resection and immediate pedicled pectoralis major myocutaneous flap (PMMF) reconstruction (2017-2024). Outcomes included surgical parameters, University of Washington Quality of Life (UW-QoL) scores at 6 months, and disease-free survival (DFS).

Results: All patients achieved R0 resection with 100% flap survival. Mean operative time was 276±24 minutes, with no major complications (Clavien-Dindo ≥III). UW-QoL scores demonstrated significant functional recovery: pain control (75.6±3.2), swallowing (78.6±5.1), and speech (95.7±2.4), with total scores exceeding 800/1200 in all cases. Over a mean follow-up of 35.1 months (range: 6-84), DFS was 100%. Four high-risk patients received adjuvant radiotherapy (50-70 Gy) without acute toxicity.

Conclusions: PMMF reconstruction provides a technically accessible solution for locally advanced head and neck MSFT, enabling radical tumor clearance while optimizing functional rehabilitation and QoL. The absence of microvascular anastomosis and a low morbidity profile make it particularly suitable for resource-constrained settings. Prospective multicenter studies are needed to validate these findings.