Assessing Complications and Outcomes of Pectoralis Major Myocutaneous Flap in Head and Neck Oncology: Insights from 150 Cases.

Abstract

Background: Reconstruction after tumor removal in the head and neck region presents a challenge for balancing functionality and aesthetics. The pectoralis major myocutaneous flap (PMMC) is a reliable option for post-tumor resection reconstruction. However, complications such as flap necrosis, detachment, donor site tumor recurrence, wound infections, and wound dehiscence have been encountered in 150 cases where PMMC was utilized. This retrospective study focuses on analyzing the complications and experiences associated with using PMMC in head and neck oncology.

Materials and methods: This analysis looks back at 150 cases of head and neck oncology that underwent PMMC flap reconstruction. Of these cases, 128 (85.3%) involved buccal mucosa reconstruction, while 22 (14.7%) focused on the tongue, floor of the mouth, and neck. Out of the total 150 cases, 141 cases (94%) were male, and 9 cases (6%) were female. We carefully documented any complications, paying specific attention to flap necrosis, detachment, donor site tumor recurrence, flap retraction, oro-cutaneous fistula, wound infections, and wound dehiscence.

Results: The study result concluded following complications were encountered, and there were instances of flap necrosis observed in 9 cases (6%). Additionally, 16 cases (10.7%) experienced flap detachment, which impacted postoperative recovery and necessitated further interventions, and 11 cases (7.3%) had flap retraction. Three cases (2%) exhibited tumor recurrence at the donor site following PMMC flap harvesting. Wound infections were prevalent, affecting 13 patients (8.6%). Two patients (1.3%) experienced donor site wound dehiscence postoperatively, and five patients (3.3%) had oro-cutaneous fistula.

Conclusion: The use of PMMC flaps in head and neck oncology requires careful consideration, surgical expertise, and postoperative care to minimize complications. Although it has been historically significant and useful, advanced surgical techniques and postoperative care protocols are necessary to optimize outcomes in PMMC flap reconstructions. Therefore, meticulous patient selection and vigilant postoperative care are essential for addressing and minimizing complications.