Journal Article

Enhanced Morbidity of Pectoralis Major Myocutaneous Flap Used for Salvage after Previously Failed Oncological Treatment and Unsuccessful Reconstructive Head and Neck Surgery

Ribeiro Salles Vanni, Christiana Maria, Cernea, Cláudio Roberto, Faro Junior, Mário Paulo, Ledo Kanda, Jossi, Pinto, Fábio Roberto, Garcia Brandão, Lenine, de Matos, Leandro Luongo

2012

Overview

Introduction. The reconstruction of complex cervicofacial defects arising from surgical treatment for cancer is a real challenge for head and neck surgeons, especially in salvage reconstruction surgery and/or failed previous reconstruction. The pectoralis major myocutaneous flap (PMMF) has been widely used in these specific situations due to its reliability and low rate of failure or complications. Objectives. Identify factors that determine complications and influence the final outcome of the reconstructions with PMMF in salvage cancer surgery or in salvage reconstruction. Methods. A cross-sectional study design was used to evaluate a sample including 17 surgical patients treated over a period of ten years that met the inclusion criteria. Results. Reconstruction was successful in 13 cases (76.5%), with two cases of partial flap loss and no case of total loss. Complications occurred in 13 cases (76.5%) and were specifically related to the flap in nine instances (52.9%). An association was identified between the development of major complications and reconstruction of the hypopharynx (P=0.013) as well as in patients submitted to surgery in association with radiation therapy as a previous cancer treatment (P=0.002). The former condition is also associated with major reconstruction failure (P=0.018). An even lower incidence of major complications was noted in patients under the age of 53 (P=0.044). Conclusion. Older patients, with hypopharyngeal defects and submitted to previous surgery plus radiation therapy, presented a higher risk of complications and reconstruction failure with PMMF.

• Publisher: Hindawi Puplishing Corporation,The Scientific World Journal,John Wiley & Sons, Inc,Wiley
• Subject: Adult / Aged / Cancer / Carcinoma, Squamous Cell - mortality / Carcinoma, Squamous Cell - surgery / Clinical Study / Cross-Sectional Studies / Defects / Failure / Head - surgery / Head and Neck Neoplasms - mortality / Head and Neck Neoplasms - surgery / Humans / Hypopharynx / Male / Medical Oncology - methods / Middle Aged / Morbidity / Neck / Patients / Pectoralis Muscles - surgery / Pectoralis Muscles - transplantation / Postoperative Complications - epidemiology / Radiation therapy / Reconstruction / Reconstructive surgery / Reconstructive Surgical Procedures - adverse effects / Reliability aspects / Reproducibility of Results / Salvage / Salvage Therapy - methods / Surgery / Surgical Flaps / Treatment Outcome