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Opango ADC, Aziz Z, Jaifi A, Ndelafei D, El Fatihi M, Mansouri Hattab N. Pectoral major myocutaneous flap in our practice: about 25 cases. J Surg Case Rep 2024; 2024:rjae448. [PMID: 38979091 PMCID: PMC11227888 DOI: 10.1093/jscr/rjae448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/19/2024] [Accepted: 06/25/2024] [Indexed: 07/10/2024] Open
Abstract
The pectoralis major myocutaneous flap (PMMF) was described by Ariyan in 1979 for head and neck reconstructions. It is a safe flap, currently supplanted by free flaps in developed countries, but which remains very useful in developing countries. We report a series of 25 cases of PMMF reconstruction. All patients were treated for advanced stages of oral cavity cancer, where tumor excision left significant tissue loss. The reconstruction used PMMF, taken using the same technique. Supplanted by free flaps in developed countries, PMMF remains useful in developing countries. It is a flap that has numerous advantages (ease of collection, viability, low requirements in terms of instrumentation, etc.). Many variations have been described over the years.
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Affiliation(s)
- Alban Déo Christian Opango
- Stomatology and Maxillofacial Surgery Department, Mohammed VI University Hospital, Marrakech 40000, Morocco
| | - Zakaria Aziz
- Stomatology and Maxillofacial Surgery Department, Mohammed VI University Hospital, Marrakech 40000, Morocco
| | - Abdelghafour Jaifi
- Stomatology and Maxillofacial Surgery Department, Mohammed VI University Hospital, Marrakech 40000, Morocco
| | - Divina Ndelafei
- Stomatology and Maxillofacial Surgery Department, Mohammed VI University Hospital, Marrakech 40000, Morocco
| | - Meriem El Fatihi
- Stomatology and Maxillofacial Surgery Department, Mohammed VI University Hospital, Marrakech 40000, Morocco
| | - Nadia Mansouri Hattab
- Stomatology and Maxillofacial Surgery Department, Mohammed VI University Hospital, Marrakech 40000, Morocco
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Choudhury A, Laxmidhar MI, Ahirwar N. Has the Pectoralis Major flap Really Become Obsolete? Indian J Otolaryngol Head Neck Surg 2023; 75:2172-2176. [PMID: 37636713 PMCID: PMC10447656 DOI: 10.1007/s12070-023-03842-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/28/2023] [Indexed: 08/29/2023] Open
Abstract
Aim To evaluate the current role of pectoralis major (PM) flap including the reasons for selecting it over free flaps. Materials and methods All patients who underwent PM flap at Apollo Hospitals Ahmedabad during the 3-year period from January 2020 to December 2022 were included. Patient demographics, tumour characteristics and complications were studied and reasons for selecting pectoralis major flap were analyzed. Data was entered in Microsoft excel spreadsheet and analyzed using online statistical calculators. The p value of < 0.05 was considered statistically significant. Results 57 patients underwent reconstruction with PM flap while 154 patients underwent free flap reconstruction. 54 were male and 3 were female. Median age was 51 years. PM flap was used for intraoral lining in 25 patients, and it was bilobed in 26 patients with full thickness cheek defect. Most common complication was wound infection seen in 10 patients. 5 patients developed marginal necrosis of the flap and 5 had donor site wound dehiscence. No complete flap loss was seen. During the same period, 15/154 (9.74%) patients with free flaps developed complete flap necrosis and this was statistically significant (p = 0.012). Reasons for choosing PM flap were also analyzed. 14 patients had major comorbidities, 18 had extensive disease, in 5 patients it was used for salvage post free flap failure, while 10 previously treated patients had unavailability of suitable vessels for anastomosis. 12 patients underwent PM flap due to financial constraints. Conclusion Thus, PM flap is not obsolete and continues to maintain its place in head and neck reconstruction.
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Affiliation(s)
- Arpan Choudhury
- Department of Surgical Oncology, Apollo Hospitals Ahmedabad, Plot No.1 A, Bhat GIDC Estate, 382428 Gandhinagar, India
| | - Murtuza I Laxmidhar
- Department of Surgical Oncology, Apollo Hospitals Ahmedabad, Plot No.1 A, Bhat GIDC Estate, 382428 Gandhinagar, India
| | - Neelam Ahirwar
- Department of Surgical Oncology, Apollo Hospitals Ahmedabad, Plot No.1 A, Bhat GIDC Estate, 382428 Gandhinagar, India
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Deng L, Li Y, Li W, Liu M, Xu S, Peng H. Management of refractory cervical anastomotic fistula after esophagectomy using the pectoralis major myocutaneous flap. Braz J Otorhinolaryngol 2022; 88:53-62. [PMID: 32600962 PMCID: PMC9422472 DOI: 10.1016/j.bjorl.2020.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/03/2020] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION A refractory cervical anastomotic fistula which postoperatively remains unhealed for more than 2 months under conservative care severely impacts the quality of life of the patient and potentially leads to anastomotic stricture after the fistula heals. It is widely accepted that, to avoid this complication, refractory cervical anastomotic fistulas should undergo more aggressive treatments. However, when and which surgical intervention should be considered is unclear. OBJECTIVE This study was designed to evaluate the role of the pectoralis major myocutaneous flap in the management of refractory cervical anastomotic fistulas based on our experience of 6 cases and a literature review. METHODS Six patients diagnosed with refractory cervical anastomotic fistula after esophagectomy treated using pectoralis major myocutaneous flap transfer were included in the study. The clinical data, surgical details, and treatment outcome were retrospectively analyzed. RESULTS All patients survived the operations. One patient who had a circumferential anastomotic defect resulting from surgical exploration developed a mild fistula in the neo-anastomotic site in the 5th postoperative day, which healed after 7 days of conservative care. This patient developed an anastomotic stricture which was partially alleviated by an endoscopic anastomotic dilatation. All the other 5 patients had uneventful recoveries after operations and restored oral intake on the 10th-15th days after operation, and they tolerated normal diets without subsequent sequelae on follow-up. One patient developed both local and lung recurrence and died in 15 months after operation, while the other 5 patients survived with good tumor control during the follow-up of 25-53 months. CONCLUSION The satisfactory treatment outcome in our study demonstrates that pectoralis major myocutaneous flap reconstruction is a reliable management modality for refractory cervical anastomotic fistulas after esophagectomy, particularly for those patients who experienced persistent fistulas after conservative wound care and repeated wound closures.
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Affiliation(s)
- Lifei Deng
- Cancer Hospital of Jiangxi Province, Department of Head and Neck Surgery, Nanchang, Jiangxi, China
| | - Yan Li
- Cancer Hospital of Shantou University Medical College, Department of Gynecology, Shantou, Guangdong, China
| | - Weixiong Li
- Chaozhou People's Hospital, Department of Head and Neck Surgery, Chaozhou, Guangdong, China
| | - Muyuan Liu
- Cancer Hospital of Shantou University Medical College, Department of Head and Neck Surgery, Shantou, Guangdong, China
| | - Shaowei Xu
- Cancer Hospital of Shantou University Medical College, Department of Head and Neck Surgery, Shantou, Guangdong, China
| | - Hanwei Peng
- Cancer Hospital of Shantou University Medical College, Department of Head and Neck Surgery, Shantou, Guangdong, China.
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Revisiting the sternocleidomastoid flap as a reconstructive option in head and neck surgery. The Journal of Laryngology & Otology 2019; 133:742-746. [DOI: 10.1017/s0022215119001592] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackgroundThe sternocleidomastoid can be used as a pedicled flap in head and neck reconstruction. It has previously been associated with high complication rates, likely due in part to the variable nature of its blood supply.ObjectiveTo provide clinicians with an up-to-date review of clinical outcomes of sternocleidomastoid flap surgery in head and neck reconstruction, integrated with a review of vascular anatomical studies of the sternocleidomastoid.MethodsA literature search of the Medline and Web of Science databases was conducted. Complications were analysed for each study. The trend in success rates was analysed by date of the study.ResultsReported complication rates have improved over time. The preservation of two vascular pedicles rather than one may have contributed to improved outcomes.ConclusionThe sternocleidomastoid flap is a versatile option for patients where prolonged free flap surgery is inappropriate. Modern vascular imaging techniques could optimise pre-operative planning.
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New aspects in free flap surgery: Mini-perforator flaps and extracorporeal flap perfusion. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2017. [PMID: 28642191 DOI: 10.1016/j.jormas.2017.06.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND The scope of microvascular tissue transfer in the Head and Neck reaches from coverage of simple soft tissue defects to complex 3-D reconstructions using multiple or chimeric flaps. This paper summarises the presentation given at the Congress of the French Society of Oral and Maxillofacial Surgery in Marseille 2017. It was the aim of our work to add further elements to this wide spectrum of reconstructive possibilities. METHODS For patients with small intraoral soft tissue defects in whom the use of a radial forearm flap would not be justified because of its donor site morbidity, but who nevertheless would take a benefit from a small free flap, we used mini-perforator flaps from the lower leg. These flaps were raised with negligible morbidity. Moreover, for patients necessarily needing a free flap, but having vessel depleted, irradiated necks, we have developed a first idea of extracorporeal flap perfusion to make microvascular anastomoses unnecessary. RESULTS Using donor sites from the lower leg, mini-soleus and medial sural perforator flaps were raised to cover defects of 2×3 to 2×4cm at the anterior floor of the mouth or lateral tongue. The success rate was 91%, and despite their small size, the flaps helped to maintain the mobility of the tongue. The donor site morbidity was minimal. After extensive experimental work on small animals and human tissue, four flaps could successfully be transferred so far by means of extracorporeal perfusion. In these patients, autonomisation took place between 5 and 12 days. CONCLUSIONS Although microvascular tissue transfer already allows for reconstruction in almost any possible defect constellation, mini-perforator flaps and machine-perfused transplants seem to represent new aspects of free flap surgery, being useful extensions of the reconstructive surgeon's armament.
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Wusiman P, Tuerxun J, Ling W, Tuerdi M, Maimaiti A, Tao YZ, Saimait A, Mijiti A, Moming A. Middle and Lower Face Soft Tissue Reconstruction: A 10-Year Retrospective Study. Indian J Otolaryngol Head Neck Surg 2016; 68:307-13. [PMID: 27508131 DOI: 10.1007/s12070-015-0895-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 09/08/2015] [Indexed: 11/25/2022] Open
Abstract
Retrospectively analyze the reconstruction methods and surgical outcomes of patients with middle and lower face soft tissue defects treated at our hospital over the past 10 years. 200 patients with middle and lower face soft tissue defects were surgically reconstructed at our hospital. Medical charts were retrospectively reviewed and analyzed to abstract the pertinent information. The lesion was mainly at the eyelid, lips, chin and nasal-cheek region. There were 41 (63.08 %) men and 24 (36.92 %) women. In our study, male to female ratio = 1.7:1. We used direct closure for night patients, local flap for 141 patients, free flap for 38 patients, combined flap for 12 patients involving extensive mid face and lower face defects. Most patients had their tumor resected and reconstructed in single stage procedure mostly with local advancement flap, and no flap failure was presented post-operatively. Middle and lower face soft tissue defects can be successfully treated with local flap in a single stage approach and step-by-step approach.
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Affiliation(s)
- Patiguli Wusiman
- Department of Oral and Maxillofacial Surgery, The First Teaching Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang People's Republic of China ; Stomatology Disease Institute of Xinjiang Uyghur Autonomous Region, Urumqi, 830054 Xinjiang People's Republic of China
| | - Julaiti Tuerxun
- Department of Oral and Maxillofacial Surgery, The First Teaching Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang People's Republic of China ; Stomatology Disease Institute of Xinjiang Uyghur Autonomous Region, Urumqi, 830054 Xinjiang People's Republic of China
| | - Wang Ling
- Department of Oral and Maxillofacial Surgery, The First Teaching Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang People's Republic of China ; Stomatology Disease Institute of Xinjiang Uyghur Autonomous Region, Urumqi, 830054 Xinjiang People's Republic of China
| | - Maimaitituerxun Tuerdi
- Department of Oral and Maxillofacial Surgery, The First Teaching Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang People's Republic of China ; Stomatology Disease Institute of Xinjiang Uyghur Autonomous Region, Urumqi, 830054 Xinjiang People's Republic of China
| | - Abudukelimujiang Maimaiti
- Department of Oral and Maxillofacial Surgery, The First Teaching Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang People's Republic of China ; Stomatology Disease Institute of Xinjiang Uyghur Autonomous Region, Urumqi, 830054 Xinjiang People's Republic of China
| | - Yao Zhi Tao
- Department of Oral and Maxillofacial Surgery, The First Teaching Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang People's Republic of China ; Stomatology Disease Institute of Xinjiang Uyghur Autonomous Region, Urumqi, 830054 Xinjiang People's Republic of China
| | - Adilijiang Saimait
- Department of Oral and Maxillofacial Surgery, The First Teaching Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang People's Republic of China ; Stomatology Disease Institute of Xinjiang Uyghur Autonomous Region, Urumqi, 830054 Xinjiang People's Republic of China
| | - Ainiwaer Mijiti
- Department of Oral and Maxillofacial Surgery, The First Teaching Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang People's Republic of China ; Stomatology Disease Institute of Xinjiang Uyghur Autonomous Region, Urumqi, 830054 Xinjiang People's Republic of China
| | - Adili Moming
- Department of Oral and Maxillofacial Surgery, The First Teaching Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang People's Republic of China ; Stomatology Disease Institute of Xinjiang Uyghur Autonomous Region, Urumqi, 830054 Xinjiang People's Republic of China
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Treatment of breast deformity with free deep inferior epigastric perforator flap secondary to pectoralis major flap harvesting. FORMOSAN JOURNAL OF SURGERY 2014. [DOI: 10.1016/j.fjs.2013.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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8
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Twieg M, Reich W, Dempf R, Eckert AW. [Renaissance of pedicled flaps in oral and maxillofacial surgery]. Chirurg 2014; 85:529-36. [PMID: 24449079 DOI: 10.1007/s00104-013-2638-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
A retrospective analysis in the period 2007 to 2011 included 71 surgically treated patients for carcinoma of the head and neck region and subsequent reconstruction with 36 pedicled distant flaps and 47 free flaps. Patient specific parameters of data collection with SPSS 17.0 were age and sex distribution, TNM stage and treatment. The specific type of flap reconstruction, duration of surgery, complications, intensive care and inpatient treatment were recorded. The results showed that the healing process was uneventful in 26 (72.2 %) pedicled flaps, 14 (38.9 %) pedicled flaps were transplanted in a preoperatively irradiated area of the head and neck region and in 86.0 % with a positive healing process. Tumor stage, general physical condition of the patient and type of therapy are the key parameters for the choice of reconstruction.
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Affiliation(s)
- M Twieg
- Universitätsklinik und Poliklinik für Mund-, Kiefer- und Plastische Gesichtschirurgie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle/Saale, Deutschland,
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9
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Avery C. A perspective on the role of the pectoralis major flap in oral and maxillofacial oncology surgery. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/ors.12080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- C. Avery
- University Hospitals of Leicester; Leicester UK
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10
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Fang QG, Shi S, Zhang X, Li ZN, Liu FY, Sun CF. Assessment of the quality of life of patients with oral cancer after pectoralis major myocutaneous flap reconstruction with a focus on speech. J Oral Maxillofac Surg 2013; 71:2004.e1-2004.e5. [PMID: 24135522 DOI: 10.1016/j.joms.2013.07.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 07/02/2013] [Accepted: 07/15/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of the present study was to evaluate the quality of life (QoL) of patients with oral cancer who had undergone resection of the tongue and floor of the mouth and reconstruction with the pectoralis major flap. MATERIALS AND METHODS The present study assessed 21 patients who had undergone pectoralis major flap reconstruction using the University of Washington QoL, version 4, questionnaire. A nonparametric Mann-Whitney U test was used to analyze the data. RESULTS Of the 12 disease-specific domains, the best 3 scores from the patients were for pain, saliva, and anxiety, and the worst 3 scores were for taste, chewing, and swallowing. The mean UW-QoL composite score was 73.4. Swallowing was considered to be the most important issue within the previous 7 days, followed by chewing and speech. Those patients who had undergone wider excision had poorer speech. CONCLUSIONS A significant effect was found on the QoL of patients with oral cancer who had undergone resection of the tongue and floor of the mouth with pectoralis major flap reconstruction.
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Affiliation(s)
- Qi-Gen Fang
- Resident, Department of Oromaxillofacial-Head and Neck Surgery, Department of Oral and Maxillofacial Surgery, China Medical University School of Stomatology, Heping District, Shenyang, Liaoning, People's Republic of China
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11
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Avery CME, Gandhi N, Peel D, Neal CP. Indications and outcomes for 100 patients managed with a pectoralis major flap within a UK maxillofacial unit. Int J Oral Maxillofac Surg 2013; 43:546-54. [PMID: 24220666 DOI: 10.1016/j.ijom.2013.10.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 10/04/2013] [Accepted: 10/09/2013] [Indexed: 11/26/2022]
Abstract
There are few studies reporting the role of the pedicled pectoralis major (PPM) flap in modern maxillofacial practice. The outcomes of 100 patients (102 flaps) managed between 1996 and 2012 in a UK maxillofacial unit that preferentially practices free tissue reconstruction are reported. The majority (88.2%) of PPM flaps were for oral squamous cell carcinoma (SCC), stage IV (75.6%) disease, and there was substantial co-morbidity (47.0% American Society of Anesthesiologists 3 or 4). The PPM flap was the preferred reconstruction on 80.4% of occasions; 19.6% followed free flap failure. Over half of the patients (57%) had previously undergone major surgery and/or chemoradiotherapy. Ischaemic heart disease (P=0.028), diabetes mellitus (P=0.040), and methicillin-resistant Staphylococcus aureus (MRSA) infection (P=0.013) were independently associated with flap loss (any degree). Free flap failure was independently associated with total (2.0%) and major (6.9%) partial flap loss (P=0.044). Cancer-specific 5-year survival for stage IV primary SCC and salvage surgery improved in the second half (2005-2012) of the study period (22.2% vs. 79.8%, P=0.002, and 0% vs. 55.7%, P=0.064, respectively). There were also declines in recurrent disease (P=0.008), MRSA (P<0.001), and duration of admission (P=0.014). The PPM flap retains a valuable role in the management of advanced disease combined with substantial co-morbidity, and following free flap failure.
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Affiliation(s)
- C M E Avery
- Department of Maxillofacial Surgery, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK.
| | - N Gandhi
- University of Birmingham, Birmingham, UK
| | - D Peel
- Department of Clinical Oncology, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK
| | - C P Neal
- Department of Surgery, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK
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12
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You YH, Chen WL, Zhang DM. Closure of large oropharyngocutaneous fistulas using a folded extensive supraclavicular fasciocutaneous island flap. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY MEDICINE AND PATHOLOGY 2013. [DOI: 10.1016/j.ajoms.2012.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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13
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Zan T, Li H, Du Z, Gu B, Liu K, Xie F, Xie Y, Li Q. Reconstruction of the face and neck with different types of pre-expanded anterior chest flaps: A comprehensive strategy for multiple techniques. J Plast Reconstr Aesthet Surg 2013; 66:1074-81. [DOI: 10.1016/j.bjps.2013.04.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 03/25/2013] [Accepted: 04/01/2013] [Indexed: 10/26/2022]
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Beasley N. Expert's comment concerning grand rounds case entitled ''postoperative pharyngocutaneous fistula: treated with sternocleidomastoid flap repair and cricopharyngeus myotomy'' (by V.A. Iyoob). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:113-5. [PMID: 23001379 PMCID: PMC3540305 DOI: 10.1007/s00586-012-2453-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Accepted: 07/05/2012] [Indexed: 10/27/2022]
Abstract
Great care should be taken to minimise damage to the pharynx and upper oesophagus during an anterior approach to the cervical spine. If noticed at the time of surgery primary repair should be carried out; if noticed in the postoperative period, thorough cleaning and placement of a pharyngocutaneous drain will result in spontaneous healing of the majority of fistula. For persistent fistula secondary repair is required using well-vascularised tissue.
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Affiliation(s)
- Nigel Beasley
- ENT, Nottingham University Hospital, Derby Road, Nottingham, NG3 5DU, UK.
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Infraareolar pectoralis major myocutaneous island flap as treatment of first choice for deep sternal wound infection. J Plast Reconstr Aesthet Surg 2012; 66:187-92. [PMID: 23102609 DOI: 10.1016/j.bjps.2012.09.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 09/19/2012] [Accepted: 09/21/2012] [Indexed: 11/24/2022]
Abstract
Deep sternal wound infection (DSWI) is a grave complication of median sternotomy, associated with high morbidity, mortality and escalating treatment costs. There is general consensus that optimal treatment comprises radical debridement followed by coverage with a vascularised flap. However, there is ongoing debate regarding the ideal operative procedure. We present our experience with the infraareolar pectoralis major island myocutaneous flap (PEC-MI flap) as treatment of first choice in DSWI. Following a retrospective chart review, data pertaining to patient demographics, type of cardiac surgery performed, prevalence of known DSWI risk factors, identified pathogens, duration of surgery, flap-related complications, duration of hospital stay and antibiotic therapy, as well as mortality were noted. Additionally, we describe the operative technique and review the relevant literature. Twenty-five patients underwent coverage with the PEC-MI flap in our department. The average age was 69.2 years. Nineteen patients underwent coronary artery bypass surgery, 10 valve replacement, two aortic replacement surgery and one pericardiectomy. In six cases, no internal mammary artery was used in cardiac surgery, in 11 cases one and in seven cases both internal mammary arteries were used. The average duration of surgery was 154.2 min and the average hospital stay was 28.4 days. Complications which required revision surgery were haematoma in three cases, one wound dehiscence and one recurrent infection. Two cases required coverage with an additional regional flap. The PEC-MI flap has been used as flap of first choice in our clinic for treatment of DSWI. It is sufficient to raise the flap unilaterally, and it does not require skin grafting. The combination of immunocompetent bulky muscle tissue used to obliterate the sternal cavity and the large skin paddle enabling a low-tension skin closure allows reliable and efficient treatment of this severe complication.
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16
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Tang CL, Wu YC, Lai CH, Lai CS, Lin CL, Lin SD, Chang KP. Salvage for pectoralis major myocutaneous flap failure in head and neck reconstruction by microvascular flap. J Plast Surg Hand Surg 2012; 46:335-8. [PMID: 22998147 DOI: 10.3109/2000656x.2012.718281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The pectoralis major myocutaneous pedicled flap (PMMPF) - the "workhorse" for head and neck reconstruction - is associated with a high incidence of complications in certain cases. This study presents free tissue transfer as an alternative salvage technique after PMMPF failure in head and neck reconstruction. It includes seven consecutive patients who underwent free tissue salvage after PMMPF failure in head and neck reconstruction from January 2008 to September 2010 at Kaohsiung Medical University Hospital, Taiwan. Four vertical rectus abdominis myocutaneous (VRAM) flaps were applied for tongue and mouth floor defects, while three anterolateral thigh (ALT) flaps were used for mouth floor, buccal, and cheek defects. All flaps survived uneventfully, and normal oral feeding was achieved without major complications. Free tissue transfer has several advantages and can be successfully employed in head and neck reconstruction, and it is also a reliable salvage procedure after PMMPF failure in such cases.
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Affiliation(s)
- Chen-Ling Tang
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Kekatpure VD, Trivedi NP, Manjula BV, Mathan Mohan A, Shetkar G, Kuriakose MA. Pectoralis major flap for head and neck reconstruction in era of free flaps. Int J Oral Maxillofac Surg 2012; 41:453-7. [PMID: 22260790 DOI: 10.1016/j.ijom.2011.12.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 10/16/2011] [Accepted: 12/19/2011] [Indexed: 11/29/2022]
Abstract
The aim of this study was to evaluate factors affecting the selection of pectoralis major flap in the era of free tissue reconstruction for post ablative head and neck defects and flap associated complications. The records of patients who underwent various reconstructive procedures between July 2009 and December 2010 were retrospectively analysed. 147 reconstructive procedures including 79 free flaps and 58 pectoralis major flaps were performed. Pectoralis major flap was selected for reconstruction in 21 patients (36%) due to resource constrains, in 12 (20%) patients for associated medical comorbidities, in 11 (19%) undergoing extended/salvage neck dissections, and in 5 patients with vessel depleted neck and free flap failure salvage surgery. None of the flaps was lost, 41% of patients had flap related complications. Most complications were self-limiting and were managed conservatively. Data from this study suggest that pectoralis major flap is a reliable option for head and neck reconstruction and has a major role even in this era of free flaps. The selection of pectoralis major flap over free flap was influenced by patient factors in most cases. Resource constraints remain a major deciding factor in a developing country setting.
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Affiliation(s)
- V D Kekatpure
- Department of Head and Neck Oncology, Mazumdar-Shaw Cancer Center, Narayana Hrudayalaya, Health City, Bangalore,
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