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Nandy K, Jayaprakash D, Bhatt S, Mithi M, Kumar P, Rathod P. Bilobed Pectoralis Major Myocutaneous Flap Reconstruction: a Single Institution Experience of 150 Patients and Methods to Prevent Complications. J Maxillofac Oral Surg 2024; 23:248-257. [PMID: 38601219 PMCID: PMC11001805 DOI: 10.1007/s12663-020-01485-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: 04/02/2020] [Accepted: 11/21/2020] [Indexed: 10/22/2022] Open
Abstract
Introduction Bilobed PMMC flap is done for patients who have diseases that require resection of oral cavity mucosa along with the overlying skin, either because of direct tumor invasion to the skin or for achieving adequate tumor-free base of resection. The versatility of the flap allows it to be used to cover both inner and outer linings for a full-thickness defect. Materials and Methods This was a single-center, retrospective, observational study carried out in the Department of Head and Neck Oncology at a regional cancer center from January 2019 to December 2019. A minimum follow-up duration for all patients was 6 months. The primary endpoint was to study the results and complications associated with bilobed PMMC flap reconstruction and factors affecting it, as well as their management. Results The median age was 45 years [24-71 years]. There were 96(64%) males and 54(36%) females. The most common sites reconstructed were lower gingivobuccal sulcus (39.1%), buccal mucosa (30.2%), and lower alveolus (16.7%). The overall complication rate was 41.3%, with 10(6.6%) patients requiring re-exploration. The average hospital stay was 11 days [5-28 days]. On doing a multivariate analysis, for various factors affecting flap necrosis, none of the factors reached statistical significance (p value > 0.05). Conclusion PMMC flap remains the workhorse of head and neck reconstruction. In cases of full-thickness defects in oral cancer patients, in our country, in the setup which lacks the expertise in microvascular anastomosis and with immense caseload in the head and neck cancer department, bilobed PMMC flap remains a safe and favorite alternative method for reconstruction.
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Affiliation(s)
- Kunal Nandy
- Department Of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat India
| | - Dipin Jayaprakash
- Department Of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat India
| | - Supreet Bhatt
- Department Of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat India
| | - Mohamad Mithi
- Department Of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat India
| | - Prachur Kumar
- K.M. Shah Dental College, Sumandeep Vidyapeeth Piparia, Vadodara, Gujarat India
| | - Priyank Rathod
- Department Of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat India
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Ko SH, Park SH, Jang SM, Lee KJ, Kim KH, Jeon YD. Multimodal nerve injection provides noninferior analgesic efficacy compared with interscalene nerve block after arthroscopic rotator cuff repair. J Orthop Surg (Hong Kong) 2021; 29:23094990211027974. [PMID: 34278884 DOI: 10.1177/23094990211027974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE This randomized noninferiority trial aimed to evaluate whether combined suprascapular, axillary nerve, and the articular branch of lateral pectoral nerve block (3NB) is noninferior to interscalene nerve block (ISB) for pain control after arthroscopic rotator cuff repair (ASRCR). MATERIALS AND METHODS Eighty-five patients undergoing ASRCR were randomized to either 3NB (n = 43) or ISB (n = 42) group. We used 5 and 15 ml of 0.2% ropivacaine for each nerve in the 3NB and ISB groups, respectively. The primary outcome was the visual analog scale (VAS) pain score at 4 h postoperatively measured assessed on an 11-point scale (ranging from 0 = no pain to 10 = worst pain) that was analyzed using noninferiority testing. The secondary outcome was VAS pain scores in the recovery room and at 8, 12, 24, 36, 48, and 72 h postoperatively. Rebound pain, IV-PCA usage during 48 h, dyspnea, muscle weakness, and satisfaction were evaluated. RESULTS Regarding the primary outcome, the mean difference in VAS pain scores between the 3NB (2.5 ± 1.6) and ISB (2.2 ± 2.3) groups at 4 h postoperatively was 0.3, with a 95% confidence interval (CI) of -0.56 to 1.11. The upper limit of 95% CI is lower than the noninferiority margin of 1.3 (p < 0.001). At all other time points, except in the recovery room, 3NB showed noninferior to ISB. Rebound pain, IV-PCA usage during the second 24 h, and muscle weakness were lower in the 3NB group (all p < 0.005). The satisfaction was similar in both groups (p = 0.815). CONCLUSION Combined 3NB is noninferior to ISB in terms of pain control after ASRCR; and is associated with low levels of rebound pain, IV-PCA usage, and muscle weakness. LEVEL OF EVIDENCE Randomized controlled trial, Level I.
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Affiliation(s)
- Sang Hun Ko
- Department of Orthopaedic Surgery, Ulsan University College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Se Hun Park
- Department of Anesthesia and Pain Medicine, Ulsan University College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Seong Min Jang
- Department of Orthopaedic Surgery, Ulsan University College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Kyung Joo Lee
- Department of Orthopaedic Surgery, Ulsan University College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Kwang Ho Kim
- Department of Orthopaedic Surgery, Ulsan University College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Young Dae Jeon
- Department of Orthopaedic Surgery, Ulsan University College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
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Variations of Cords of Brachial Plexus and Branching Pattern of Nerves Emanating From Them. J Craniofac Surg 2018; 28:543-547. [PMID: 28033192 DOI: 10.1097/scs.0000000000003341] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Brachial plexus is complex network of nerves, formed by joining and splitting of ventral rami of spinal nerves C5, C6, C7, C8, and T1 forming trunks, divisions, and cords. The nerves emerging from trunks and cords innervate the upper limb and to some extent pectoral region. Scanty literature describes the variations in the formation of cords and nerves emanating from them. Moreover, the variations of cords of brachial plexus and nerves emanating from them have iatrogenic implications in the upper limb and pectoral region. Hence study has been carried out. Twenty-eight upper limbs and posterior triangles from 14 cadavers fixed in formalin were dissected and rare and new variations of cords were observed. Most common variation consisted of formation of posterior cord by fusion of posterior division of upper and middle trunk and lower trunk continued as medial cord followed by originating of 2 pectoral nerves from anterior divisions of upper and middle trunk. Other variations include anterior division of upper trunk continued as lateral cord and pierced the coracobrachialis, upper and middle trunk fused to form common cord which divided into lateral and posterior cords, upper trunk gave suprascapular nerve and abnormal lateral pectoral nerve and formation of median nerve by 3 roots. These variations were analyzed for diagnostic and clinical significance making the study relevant for surgeons, radiologists in arresting failure patients and anatomists academically in medical education.
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Nam YS, Panchal K, Kim IB, Ji JH, Park MG, Park SR. Anatomical study of the articular branch of the lateral pectoral nerve to the shoulder joint. Knee Surg Sports Traumatol Arthrosc 2016; 24:3820-3827. [PMID: 26194117 DOI: 10.1007/s00167-015-3703-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 07/09/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study was to document the distribution of the articular branch of the lateral pectoral nerve (LPN) to the shoulder and to identify a suitable point for its blockade. METHODS This study involved the dissection of 43 shoulders of 22 unembalmed cadavers (6 male and 16 female) to identify the LPN and its articular branch to the shoulder. To identify the suitable anatomical point for blocking the articular branch of the LPN, several anatomical landmarks around the shoulder were measured. RESULTS The articular branch of the LPN to the shoulder was present in 29 of 43 cases (67.4 %). The appropriate point to block the articular branch of the LPN was identified at a mean distance of 1.5 cm below the clavicle, on the line connecting the closest points between the clavicle and the coracoid process, and at a mean depth of 1.0 cm from the skin. CONCLUSION The articular branch of the LPN to the shoulder, as well as the muscular and cutaneous branches of the LPN, covers a portion of the shoulder joint with suprascapular and axillary nerves. Surgeons might consider a peripheral block of the suprascapular, axillary, and LPNs to provide maximum block coverage after shoulder joint surgery.
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Affiliation(s)
- Young-Seok Nam
- Department of Anatomy, Catholic Institute for Applied Anatomy, The Catholic University of Korea, Seoul, South Korea
| | - Karnav Panchal
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, 520-2, Deahung-Dong, Joong-Ku, Daejeon, 302-803, South Korea
| | - In-Beom Kim
- Department of Anatomy, Catholic Institute for Applied Anatomy, The Catholic University of Korea, Seoul, South Korea
| | - Jong-Hun Ji
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, 520-2, Deahung-Dong, Joong-Ku, Daejeon, 302-803, South Korea.
| | - Min-Gyu Park
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, 520-2, Deahung-Dong, Joong-Ku, Daejeon, 302-803, South Korea
| | - Sung-Ryeoll Park
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, 520-2, Deahung-Dong, Joong-Ku, Daejeon, 302-803, South Korea
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Jeyaraj P, Bandyopadhyay TK. Diagnostic Features and Management Strategy of a Refractory Case of Osteoradionecrosis of the Mandible: Case Report and Review of Literature. J Maxillofac Oral Surg 2016; 15:256-67. [PMID: 27298551 PMCID: PMC4871838 DOI: 10.1007/s12663-015-0833-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 07/30/2015] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Osteoradionecrosis of the jaws produces a considerable amount of esthetic as well as functional deficits seriously affecting quality of life of the patient. Cases are often notoriously difficult to treat and manage owing to associated comorbidities of the patient, post irradiation fibrosis and decreased vascularity at the site, which complicates free tissue flap and graft transfer, that subsequently succumb to failure. Hyperbaric oxygen therapy (HBOT), in which 100 % oxygen is administered by mask under 2.4 atm pressure, in a hyperbaric oxygen chamber, helps by increasing local vascularity. AIM AND METHODS It was the aim of this study to show that a particularly refractory, compromised and challenging case of osteoradionecrosis can be managed successfully even without HBOT, by mandibular segmental resection followed by reconstruction using a titanium reconstruction plate enveloped within a pedicled Pectoralis Major Myocutaneous flap. RESULT Post operative recovery of the patient was excellent with good functional and esthetic rehabilitation of the patient with and practically nil donor site morbidity. CONCLUSION It is important to have a thorough knowledge of the clinical, radiographic, histopathologic, CT and MRI features of osteoradionecrosis of the jaws in order to make a quick and accurate confirmatory diagnosis and to overcome possible diagnostic dilemmas. The strategy of reconstruction of a large mandibular defect using a bridging titanium plate sandwiched by a healthy vascularized myocutaneous flap, following ablative surgery for ORN, has proved to be a safe and reliable option for composite mandibular defects, with gratifying long term functional and cosmetic results.
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Affiliation(s)
- Priya Jeyaraj
- />Command Military Dental Centre (Northern Command), Udhampur, Jammu & Kashmir India
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Tripathi M, Parshad S, Karwasra RK, Singh V. Pectoralis major myocutaneous flap in head and neck reconstruction: An experience in 100 consecutive cases. Natl J Maxillofac Surg 2015; 6:37-41. [PMID: 26668451 PMCID: PMC4668731 DOI: 10.4103/0975-5950.168225] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: The pectoralis major myocutaneous (PMMC) flap has been used as a versatile and reliable flap since its first description by Ariyan in 1979. In India head and neck cancer patients usually present in the advanced stage making PMMC flap a viable option for reconstruction. Although free flap using microvascular technique is the standard of care, its use is limited by the availability of expertise and resources in developing world. The aim of this study is to identify the outcomes associated with PMMC flap reconstruction. Patients and Methods: After ethical approval we retrospectively analyzed 100 PMMC flap at a tertiary care hospital from 2006 to 2013. A total of 137 PMMC flap reconstructions were performed out of which follow-up data of 100 cases were available in our record. Results: A total of 100 patients were reviewed of these 86% were of oral cavity and oropharyngeal lesions, 8% were of hypopharyngeal, 3% were of laryngeal malignancies and 3 cases were of salivary gland tumor. Most tumors (83%) were advanced (T3 or T4 lesion). 95 PMMC flap reconstruction were done as a primary procedure, and 5 were salvage procedure. PMMC flap was used to cover mucosal defect in 84 patients, skin defects in 10 patient and both in 6 patients. Overall flap related complications were 40% with a major complication in 10% and minor complications in 30%. No total flap loss occurred in any patient, major flap occurred in 6% and minor flap loss in 12%. In minor flap loss patients, necrotic changes were mostly limited to skin. Orocutaneous and pharyngocutaneous fistula developed in 12 patients. 10% patients required re-surgery after developing various flap related complications Pleural empyema developed in 3 patients. Other minor complications such as neck skin dehiscence and intra-oral flap dehiscence developed in 26 patients. Conclusion: PMMC flap is a versatile flap with an excellent reach to face oral cavity and neck region. With limited expertise and resources, it is still a workhorse flap in head and neck reconstruction.
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Affiliation(s)
- Mayank Tripathi
- Department of Surgical Oncology, Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India
| | - Sanjeev Parshad
- Department of Surgery, Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India
| | - Rajender Kumar Karwasra
- Department of Surgical Oncology, Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India ; Department of Surgery, Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India
| | - Virender Singh
- Department of Oral and Maxillofacial Surgery, PGIDS, Rohtak, Haryana, India
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Shetty P, Nayak SB, Kumar N, Thangarajan R, D'Souza MR. Origin of medial and lateral pectoral nerves from the supraclavicular part of brachial plexus and its clinical importance - a case report. J Clin Diagn Res 2014; 8:133-4. [PMID: 24701504 DOI: 10.7860/jcdr/2014/7082.4029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 12/13/2013] [Indexed: 11/24/2022]
Abstract
Knowledge of normal and anomalous formation of brachial plexus and its branches is of utmost importance to anatomists, clinicians, anesthesiologists and surgeons. Possibility of variations in the origin, course and distribution of branches of brachial plexus must be kept in mind during anesthetizing the brachial plexus, mastectomy and plastic surgery procedures. In the current case, the medial pectoral nerve arose directly from the middle trunk of the brachial plexus and the lateral pectoral nerve arose from the anterior division of the upper trunk of the brachial plexus. The lateral pectoral nerve supplied the pectoralis major and the medial pectoral nerve supplied pectoralis major and pectoralis minor muscles through two separate branches.
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Affiliation(s)
- Prakashchandra Shetty
- Associate Professor, Department of Anatomy, Melaka Manipal Medical College, Manipal University , Madhav Nagar, Manipal, Karnataka, India
| | - Satheesha B Nayak
- Professor and Head, Department of Anatomy, Melaka Manipal Medical College, Manipal University , Madhav Nagar, Manipal, Karnataka, India
| | - Naveen Kumar
- Lecturer, Department of Anatomy, Melaka Manipal Medical College, Manipal University , Madhav Nagar, Manipal, Karnataka, India
| | - Rajesh Thangarajan
- Lecturer, Department of Anatomy, Melaka Manipal Medical College, Manipal University , Madhav Nagar, Manipal, Karnataka, India
| | - Melanie Rose D'Souza
- Lecturer, Department of Anatomy, Melaka Manipal Medical College, Manipal University , Madhav Nagar, Manipal, Karnataka, India
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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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Porzionato A, Macchi V, Stecco C, Loukas M, Tubbs RS, De Caro R. Surgical anatomy of the pectoral nerves and the pectoral musculature. Clin Anat 2011; 25:559-75. [DOI: 10.1002/ca.21301] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 08/24/2011] [Accepted: 10/16/2011] [Indexed: 11/11/2022]
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Pinto FR, Malena CR, Vanni CMRS, Capelli FDA, de Matos LL, Kanda JL. Pectoralis major myocutaneous flaps for head and neck reconstruction: factors influencing occurrences of complications and the final outcome. SAO PAULO MED J 2010; 128:336-41. [PMID: 21308156 PMCID: PMC10948076 DOI: 10.1590/s1516-31802010000600005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2010] [Revised: 06/20/2010] [Accepted: 09/21/2010] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Pedicled flaps play an important role in cancer treatment centers, particularly in developing and emerging countries. The aim of this study was to identify factors that may cause complications and influence the final result from reconstructions using pectoralis major myocutaneous flaps (PMMFs) for head and neck defect repair following cancer resection. DESIGN AND SETTING Cross-sectional study at the Hospital de Ensino Padre Anchieta of Faculdade de Medicina do ABC (FMABC). METHODS Data on 58 patients who underwent head and neck defect reconstruction using PMMFs were reviewed. The final result from the reconstruction (success or failure) and the complications observed were evaluated in relation to the patients' ages, area reconstructed, disease stage, previous oncological treatment and need for blood transfusion. RESULTS There were no total flap losses. The reconstruction success rate was 93.1%. Flap-related complications occurred in 43.1% of the cases, and half of them were considered major. Most of the complications were successfully treated. Defects originating in the hypopharynx were correlated with the development of major complications (p = 0.02) and with reconstruction failure (p < 0.001). Previous oncological treatment negatively influenced the reconstruction success (p = 0.04). CONCLUSIONS Since the risk factors for developing major complications and reconstruction failure are known, it is important to heed the technical details and provide careful clinical support for patients in a more critical condition, so that better results from using PMMFs can be obtained.
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Affiliation(s)
- Fábio Roberto Pinto
- MD, PhD. Attending physician, Discipline of Head and Neck Surgery, Faculdade de Medicina do ABC (FMABC), São Bernardo do Campo, São Paulo, Brazil.
| | - Carina Rosa Malena
- MD. Resident, Discipline of Plastic Surgery, Faculdade de Medicina do ABC (FMABC), São Bernardo do Campo, São Paulo, Brazil.
| | | | - Fábio de Aquino Capelli
- MD. Attending physician, Discipline of Head and Neck Surgery, Faculdade de Medicina do ABC (FMABC), São Bernardo do Campo, São Paulo, Brazil.
| | - Leandro Luongo de Matos
- MD, MSc. Resident, Discipline of Head and Neck Surgery, Faculdade de Medicina do ABC (FMABC), São Bernardo do Campo, São Paulo, Brazil.
| | - Jossi Ledo Kanda
- MD, PhD. Regent professor, Discipline of Head and Neck Surgery, Faculdade de Medicina do ABC (FMABC), São Bernardo do Campo, São Paulo, Brazil.
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Transaxillary-subclavian transfer of pedicled latissimus dorsi musculocutaneous flap to head and neck region. J Craniofac Surg 2010; 21:771-5. [PMID: 20485045 DOI: 10.1097/scs.0b013e3181d7a3cc] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Free-tissue transfer is the reconstruction of choice for most head and neck defects. However, pedicled flaps are also used, especially in high-risk patients and after failure of a free flap. The aim of this study was to compare transaxillary-subclavian pedicled latissimus dorsi musculocutaneous (PLDMC) flap, pectoralis major musculocutaneous flap, and free-tissue transfer for head and neck reconstruction in American Society of Anesthesiologists grades II and III patients. During the last 4 years, PLDMC flap with a modified transaxillary-subclavian route for transfer to the neck was used in 8 patients, pectoralis major musculocutaneous flap was used in 7 patients, and free flaps were used in 12 patients for head and neck reconstructions. These 3 methods were compared regarding the flap dimensions, complications, flap outcome scores, hospitalization time, and cost of the treatment. Mean age of the patients, mean American Society of Anesthesiologists scores, mean dimensions of the flaps, and mean hospitalization time did not differ significantly among the 3 groups. Regarding the operation time, flap complications, outcomes, and cost of total treatment, although statistically not significant, PLDMC group offered the fastest reconstruction with highest flap outcome scores and minimum cost. Free-tissue transfer is the procedure of choice especially for functional reconstruction of head and neck region. Occasionally, there exist cases in whom a pedicled flap could offer a safer option. The PLDMC flap transferred via the transaxillary-subclavian route may be preferred than, with advantages including increased arc of rotation, safer pedicle location, shorter duration of the procedure, and reduced complication rates and costs.
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Sefa Özel M, Özel L, Toros SZ, Marur T, Yıldırım Z, Erdoğdu E, Kara M, Titiz IM. Denervation point for neuromuscular blockade on lateral pectoral nerves: a cadaver study. Surg Radiol Anat 2010; 33:105-8. [DOI: 10.1007/s00276-010-0712-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 08/05/2010] [Indexed: 11/29/2022]
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Mallet Y, El Bedoui S, Penel N, Ton Van J, Fournier C, Lefebvre J. The free vascularized flap and the pectoralis major pedicled flap options: Comparative results of reconstruction of the tongue. Oral Oncol 2009; 45:1028-31. [DOI: 10.1016/j.oraloncology.2009.05.639] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 05/26/2009] [Accepted: 05/26/2009] [Indexed: 11/24/2022]
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Koh KS, Eom JS, Kirk I, Kim SY, Nam S. Pectoralis major musculocutaneous flap in oropharyngeal reconstruction: revisited. Plast Reconstr Surg 2006; 118:1145-1149. [PMID: 17016181 DOI: 10.1097/01.prs.0000221119.00987.48] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Free tissue transfer is now favored for head and neck reconstruction following cancer resection. Its success rate is rising with the obvious advances in microsurgery. The pectoralis major musculocutaneous flap, a former workhorse in head and neck reconstruction, has been overlooked and criticized because of its seemingly high rate of complications and cosmetic inferiority, but it is still being used by many surgeons and plays an important role in head and neck reconstruction. METHODS The authors reviewed 34 pectoralis major musculocutaneous flap cases and 18 free flap cases (12 radial forearm flaps, six rectus abdominis flaps) involving oropharyngeal reconstruction. Flap necrosis, fistula formation, and operative times were compared. The pectoralis major musculocutaneous flap was elevated in true island type with maximal skeletonization of the pectoral branch of the thoracoacromial vessels. RESULTS In pectoralis major musculocutaneous cases, all defects were reconstructed successfully, with only two cases of partial necrosis that were managed conservatively. Among the free flaps, two resulted in total flap loss and were subsequently replaced with pectoralis major musculocutaneous flaps. Fistula formation did not occur in any case in either group. Mean operative time for pectoralis major musculocutaneous flap preparation was 76 +/- 7 minutes; that for free flap preparation was 145 +/- 11 minutes. CONCLUSIONS Technical refinements and meticulous procedures minimized necrosis of the pectoralis major musculocutaneous flap and guaranteed the success of the reconstruction. The free flap is an excellent method for oropharyngeal reconstruction, but the refined pectoralis major musculocutaneous flap can also produce acceptable results with minimal complications. In some instances, the pectoralis major musculocutaneous flap is not only an alternative to the free flap but a better choice that presents less risk to the patient.
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Affiliation(s)
- Kyung S Koh
- Seoul, Korea From the Departments of Plastic Surgery and Otolaryngology, Asan Medical Center, University of Ulsan, College of Medicine
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