Clinical study on feasibility of a modified pectoralis major myocutaneous flap technique with additional vascular supply and an extended rotation arc for reconstruction of surgically induced defects in oral cancer patients

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  • Kanno Takahiro
    Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
  • Nariai Yoshiki
    Division of Oral and Maxillofacial Surgery, Matsue City Hospital
  • Tatsumi Hiroto
    Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
  • Karino Masaaki
    Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine Department of Plastic, Reconstructive and Aesthetic Surgery, School of Medicine, Fukuoka University
  • Yoshino Aya
    Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
  • Koike Takashi
    Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
  • Watanabe Masaaki
    Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
  • Tsunematsu Koji
    Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
  • Sekine Joji
    Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine

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Other Title
  • 外側胸動脈系血行付与による大胸筋皮弁変法術式による口腔癌切除後再建の有用性に関する臨床的検討

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Description

The pedicled pectoralis major myocutaneous (PMMC) flap is versatile and still used for the reconstruction of surgical defects following oral, head and neck cancer resection. Although microvascularized free-tissue transfer is often used as the main flap method for oral and maxillofacial reconstruction, it cannot be used effectively in certain situations, such as in recurrence after reconstruction (salvage), poor systemic or local conditions, in arteriosclerosis, and/or in the very elderly. According to individual considerations for oral cancer treatment, the clinical benefits of the PMMC flap should not be overlooked. When harvesting the PMMC flap, we modified the conventional technique: (1)Use of the subclavian route and (2) Preservation of the lateral thoracic vessels. These modified PMMC flap preparation techniques ensure sufficient blood supply and an increased rotation arc. We have applied this modified technique instead of microvascularized free flaps or conventional PMMC flap techniques since 2013. To date, we have treated 8 patients with advanced or recurrent (salvage) oral cancer, as well as very elderly patients, with our modified technique and no critical flap problems or fistula formation have occurred. In this retrospective clinical study, we review this modified PMMC flap and compare the clinical results for the treatment of surgical defects following oral cancer resection in terms of the feasibility of additional blood supply of the lateral thoracic vessels in the clinical setting.

Journal

  • Toukeibu Gan

    Toukeibu Gan 41 (4), 411-417, 2015

    Japan Society for Head and Neck Cancer

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