Factors increasing the risk of flap complications following pectoralis major myocutaneous flap reconstruction for head and neck cancers
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20202214Keywords:
Pectoralis major myocutaneous flap, Complications, Pedicled flap, Risk factorsAbstract
Background: Oral cavity cancer is one of the most common cancers and a leading cause of cancer death in India. Pectoralis major myocutaneous flaps (PMMC) are still widely used for reconstruction of defects in the head and neck, though microvascular free flaps are the ‘gold standard’. This study was aimed to identify the risk factors involved in increasing the post-operative PMMC flap complications.
Methods: Patients who underwent surgical resection of primary head and neck cancer with PMMC flap reconstruction were included and their demographic data, pre-operative laboratory values, surgery details and post-operative flap morbidity were collected retrospectively from the master case sheets from January 2013 to December 2019. Factors such as age, gender, stage of disease, pre-operative anemia, hypoprotenemia and radiation therapy, presence of diabetes and size of the flaps were analysed to find their relation in causing flap complications.
Results: Totally 285 patients were included for analysis and 9.82% (n=28) had major flap complications. On analysis we found that pre-operative hypoproteinemia (serum albumin <3.5) (p=0.001) and prior radiation therapy (p=0.02) significantly increased the risk of flap complications. Similarly, patients with larger bipaddled flaps had higher flap complication rates (p=0.0002) and previous radiation treatment further increased the major complication rates in bipaddle flaps.
Conclusions: PMMC flaps are still a viable option for head and neck reconstruction especially in patients with multiple comorbidities and where free microvascular flaps are not done routinely. Careful patient selection, pre-operative optimisation and good post-operative care will help to reduce flap complications.
Metrics
References
Globocan India 2018. Population fact sheets. Available at: http://www.gco.iarc.fr/today/data/ factsheets/populations/356-india-fact-sheets.pdf. Accessed on 2 January 2020.
Khandekar SP, Bagdey PS, Tiwari RR. Oral cancer and some epidemiological factors: A hospital based study. Indian J Community Med. 2006;31:157-9.
Conway DI, Petticrew M, Marlborough H. Socioeconomic inequalities and oral cancer risk: a systematic review and meta-analysis of case-control studies. Int J Cancer. 2008;122:2811-9.
Sankaranarayanan R, Ramadas K, Thomas F, Muwonge K, Thara S, Mathew B, et al. Effect of screening on oral cancer mortality in Kerala, India: a cluster randomised controlled trial. Lancet. 2005;365(9475):1927-33.
Ariyan S. The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck. Plast Reconstr Surg. 1979;63(1):73-81.
Novakovic D, Patel RS, Goldstein DP, Gullane PJ. Salvage of failed free flaps used in head and neck reconstruction. Head Neck Oncol. 2009;1:33.
Wang S, Ruan Z, Liu F, Huang H, Zheng J, Song K. A rare case of circumferential intramural dissection of the thoracic esophagus. Thorac Cardiovasc Surg. 2010;58:494-5.
Pinto FR, Malena CR, Vanni CM, Capelli FD, 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.
Peng H, Wang SJ, Yang X, Lin J, Guo H, Liu M. Modified radical neck dissection for residual neck disease after radiotherapy of nasopharyngeal carcinoma. Auris Nasus Larynx. 2014;41(5):485-90.
Baek SM, Biller HF, Krespi YP, Lawson W. The pectoralis major myocutaneous island flap for reconstruction of the head and neck. Head Neck. 1979;1:293-300.
Mallet Y, El Bedoui S, Penel N, Ton Van J, Fournier C, Lefebvre JL. The free vascularized flap and the pectoralis major pedicled flap options: comparative results of reconstruction of the tongue. Oral Oncol. 2009;45:1028-31.
Avery CM, Crank ST, Neal CP, Hayter JP, Elton C. The use of the pectoralis major flap for advanced and recurrent head and neck malignancy in the medically compromised patient. Oral Oncol. 2010;46:829-33.
Liu M, Liu W, Yang X, Guo H, Peng H. Pectoralis Major Myocutaneous Flap for Head and Neck Defects in the Era of Free Flaps: Harvesting Technique and Indications. Sci Rep. 2017;7:46256.
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. 2014;43:546-54.
Sumarroca A, Rodríguez-Bauzà E, Lop-Gros J, García J, López M, Quer M, et al. Repair of post-laryngectomy pharyngocutaneous fistulas using a pectoralis major flap. Braz J Otorhinolaryngol. 2019;85:351-6.
Milenovic A, Virag M, Uglesic V, Aljinovic-Ratkovic N. The pectoralis major flap in head and neck reconstruction: first 500 patients. J Craniomaxillofac Surg. 2006;34:340-3.
IJsselstein CB, Hovius SE, Have BL, Wijthoff SJ, Sonneveld GJ, Meeuwis CA, et al. Is the pectoralis myocutaneous flap in intraoral and oropharyngeal reconstruction outdated? Am J Surg. 1996;172:259-62.
Liu R, Gullane P, Brown D, Irish J. Pectoralis major myocutaneous pedicled flap in head and neck reconstruction: retrospective review of indications and results in 244 consecutive cases at the Toronto General Hospital. J Otolaryngol. 2001;30(1):34-40.
Fang Z, Tian ZW, Zhang CP, Sun J, Hu JZ, He Y. Risk factors for pedicle flap complications in 251 elderly chinese patients who underwent oral and maxillofacial reconstruction. J Oral Maxillofac Surg. 2016;74(10):2073-80.
Aničin A, Šifrer R, Strojan P. Pectoralis Major Myocutaneous Flap in Primary and Salvage Head and Neck Cancer Surgery. J Oral Maxillofacial Surg. 2015;73(10):2057-64.
Wei W, Qiu Y, Fang Q, Jia Y. Pectoralis major myocutaneous flap in salvage reconstruction following free flap failure in head and neck cancer surgery. J Int Med Res. 2019;47:76-83.
Sun Q, Guo S, Wang D, Xu N, Jin SF, Wang C. Does pectoralis major flap harvesting induce upper extremity dysfunction? J Int Med Res. 2015;43(4):555-9.
Refos JW, Witte BI, de Goede CJ, de Bree R. Shoulder morbidity after pectoralis major flap reconstruction. Head Neck. 2016;38:1221-8.
Li W, Zhang P, Li R, Liu Y, Kan Q. Radial free forearm flap versus pectoralis major pedicled flap for reconstruction in patients with tongue cancer: Assessment of quality of life. Med Oral Patol Oral Cir Bucal. 2016;21:737-42.
Shah JP, Haribhakti V, Loree TR, Sutaria P. Complications of the pectoralis major myocutaneous flap in head and neck reconstruction. Am J Surg. 1990;160(4):352-5.
Downloads
Published
How to Cite
Issue
Section
