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Vasques LF, Kwiatkowski FV, Kwiatkowski RV, Anjos ADS, Zanatta AS, Bonow DR, Franciosi BM. Versatility of the myocutaneous pectoralis major flap in oncology reconstruction: A literature review and practical application. J Surg Oncol 2024. [PMID: 39138935 DOI: 10.1002/jso.27724] [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: 04/01/2024] [Accepted: 05/12/2024] [Indexed: 08/15/2024]
Abstract
Pectoralis major muscle flaps are considered versatile and allow large reconstructions of anatomical defects within a single surgical procedure. Considered a "workhorse" due to these characteristics, the pectoralis major muscle is an excellent option for surgical reconstruction. Several uses of this flap are described in the literature, such as protection of the jugulocarotid system after cervical lymph node dissection, oral, cervical, breast, diaphragmatic, hypopharyngeal, pharyngeal, laryngeal, and esophageal reconstructions.
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Affiliation(s)
- Luana Ferreira Vasques
- Medicine Department of Universidade Católica de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Filipe Vieira Kwiatkowski
- Surgical Oncology Department, Santa Casa de Misericórdia de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Rafael Vieira Kwiatkowski
- Surgical Oncology Department, Santa Casa de Misericórdia de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Amanda da Silva Anjos
- Internal Medicine Department, Santa Casa de Misericórdia de Curitiba, Curitiba, Parana, Brazil
| | | | - Danielle Rediess Bonow
- Medicine Department of Universidade Federal de Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
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Chaturvedi G, Kushwaha AK, Jha R, Suhag K. Evaluating Pedicled Pectoralis Major Myocutaneous Flap Reconstructions for Oral Malignancy and the Influence of Laterally Based Rotational Advancement Flap on Donor Site Integrity and Nipple Position in Male Patients. Cureus 2024; 16:e58022. [PMID: 38738011 PMCID: PMC11087882 DOI: 10.7759/cureus.58022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 05/14/2024] Open
Abstract
Oral cancer poses a significant health burden, particularly in the male population of India. This study focuses on evaluating the outcomes of 48 pedicled Pectoralis major myocutaneous (PMMC) flap reconstructions in male patients with oral malignancy. Given the challenges associated with microvascular flap reconstructions, especially in advanced cancer cases, older patients, and resource-constrained settings, the PMMC flap still serves as a valuable alternative. The study introduces a novel approach by incorporating a laterally based rotational advancement flap (LBRA) to address donor site integrity and decrease the nipple-areolar complex (NAC) displacement. Traditionally, PMMC flap designs tend to cause inward shifting of the NAC during chest donor site closure, impacting the aesthetic outcome. Surgical techniques involved wide local resection, neck dissection, and PMMC flap reconstruction. The Flap design included a horizontal orientation with adjustments based on defect location. Additionally, a laterally based rotational flap from the chest aided in donor site closure. Results demonstrate the versatility and reliability of PMMC flap reconstructions, with no total flap necrosis or major complications observed in the 48 cases. The LBRA technique effectively mitigated NAC displacement. The study contributes to the existing literature by providing insights into the advantages of PMMC flap reconstructions and introducing a technique to optimize donor site closure and decrease the medial shifting of the nipple. The adaptability, reliable vascular supply, and simplified learning curve make the PMMC flap a preferred choice in resource-constrained settings with high patient demand. In conclusion, this research underscores the continued relevance and effectiveness of the PMMC flap in head and neck reconstruction, offering satisfactory cosmetic and functional results. The introduction of the LBRA technique adds a nuanced dimension to improve outcomes, particularly in male patients with oral malignancy.
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Affiliation(s)
- Gaurav Chaturvedi
- Burns and Plastic Surgery, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Ajit K Kushwaha
- Surgical Oncology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Rohit Jha
- Surgical Oncology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Kanika Suhag
- Anaesthesia, Bhopal Memorial Hospital and Research Centre, Bhopal, IND
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Hicks MD, Ovaitt AK, Fleming JC, Sorace AG, Song PN, Mansur A, Hartman YE, Rosenthal EL, Warram JM, Thomas CM. Hyperintensity of integrin-targeted fluorescence agent IntegriSense750 accurately predicts flap necrosis compared to Indocyanine green. Head Neck 2022; 44:134-142. [PMID: 34697855 PMCID: PMC8688316 DOI: 10.1002/hed.26914] [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: 07/22/2021] [Revised: 09/17/2021] [Accepted: 10/07/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Flap necrosis is a feared complication of reconstructive surgery. Current methods of prediction using Indocyanine green (ICG) lack specificity. IntegriSense750 is a fluorescence agent that binds sites of vascular remodeling. We hypothesized that IntegriSense750 better predicts flap compromise compared to ICG. METHODS Fifteen mice underwent lateral thoracic artery axial flap harvest. Mice received an injection of ICG (n = 7) or IntegriSense750 (n = 8) daily from postoperative days (POD) 0-3 and were imaged daily. Mean signal-to-background ratios quantified the change in fluorescence as necrosis progressed. RESULTS Mean signal-to-background ratio was significantly higher for IntegriSense750 compared to ICG on POD0 (1.47 ± 0.17 vs. 0.86 ± 0.21, p = 0.01) and daily through POD3 (2.12 ± 0.70 vs. 0.96 ± 0.29, p < 0.001). CONCLUSIONS IntegriSense750 demonstrates increased signal-to-background ratio at areas of flap distress compared to ICG which may increase identification of flap necrosis and improve patient outcomes.
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Affiliation(s)
- Melanie D Hicks
- Department of Otolaryngology – Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Alyssa K Ovaitt
- Department of Otolaryngology – Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Jason C Fleming
- Liverpool Head and Neck Centre, University of Liverpool & Aintree University Hospital, Liverpool, UK
| | - Anna G Sorace
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL,Department of Radiology, University of Alabama at Birmingham, Birmingham, AL,O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | - Patrick N Song
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Ameer Mansur
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL,Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Yolanda E Hartman
- Department of Otolaryngology – Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Eben L Rosenthal
- Department of Otolaryngology – Head & Neck Surgery, Stanford University, Stanford, CA
| | - Jason M Warram
- Department of Otolaryngology – Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, AL,O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | - Carissa M Thomas
- Department of Otolaryngology – Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, AL,O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
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Comparison Between Radial Forearm Free Flap and Pectoralis Major Myocutaneous Flap for Reconstruction in Oral Cavity Cancer Patients: Assessment of the Quality of Life. J Craniofac Surg 2021; 33:906-909. [PMID: 34907949 DOI: 10.1097/scs.0000000000008423] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
ABSTRACT We aimed to evaluate the quality of life of Chinese patients after immediate reconstruction surgery on individuals with oral cavity cancer. In addition, we compared the differences between radial forearm free flap and pectoralis major myocutaneous flap. Using the University of Washington quality of life v4 questionnaire, 1:1 matched research was performed on patients received PMM or RFF flap. Chi-square test was used to analyze the variables. One hundred twenty four of 179 questionnaires were returned (69.3%). Age, N stage, and postoperative radiotherapy were similar for both groups. However, there were significant differences between two groups in gender, T stage, operation duration, and complication rate. Oral cavity cancer patients reconstructed with radial forearm free flap had better shoulder and speech functions but worse appearance domains. The results of our research provide important information for patients and physicians during their discussion of treatment programs for oral cavity cancers.
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