Skip to main content
Top
Published in: Oral and Maxillofacial Surgery 2/2015

01-06-2015 | Original Article

Is there still a role for bilobed/bipaddled pectoralis major myocutaneous flap for single-stage immediate reconstruction of post ablative oncologic full-thickness defects of the cheek?

Authors: Nitin Bhola, Anendd Jadhav, Rajiv Borle, Gaurav Khemka, Sanatan Kumar, Harshit Shrivastava

Published in: Oral and Maxillofacial Surgery | Issue 2/2015

Login to get access

Abstract

Introduction

Reconstruction of full-thickness defects of the head and neck is a challenge. In this clinical study, we assessed the role of the bilobed/bipaddled pectoralis major myocutaneous flap (PMMF) for the reconstruction of large full-thickness defects of the cheek, after resection of oral cancer.

Materials and method

After resection of oral cancer, 62 cases of through-and-through defects of the oral cavity were reconstructed using folded/bipaddled/bilobed PMMF flap. All were males and presented with locally advanced oral squamous cell carcinoma (SCC), which involved the buccal mucosa and gingivo buccal sulcus (n = 53) and gingivo buccal sulcus + lip (n = 9).

Results

All the flaps survived, and no patient developed a major complication. The most common complication in the current series was wound dehiscence. In 8 % of cases, wound dehiscence was found at the donor site; in 6.45 % of cases, dehiscence was present at the recipient site; and in 4.83 % of cases, dehiscence was present at the neck. All the wounds healed secondarily with regular dressings.

Conclusion

The bilobed/bipaddled PMMF is a straightforward and reliable flap that provides an effective mechanism to reconstruct full-thickness cheek defects while avoiding the complexity of microvascular free flaps. The bilobed/bipaddled PMMF has become our preferred reconstruction option for large full-thickness defects after resection of oral carcinoma.
Literature
1.
go back to reference Boyd JB, Morris S, Rosen IB, Gullane P, Rotstein L, Freeman JL (1994) The through-and-through oromandibular defect: rationale for aggressive reconstruction. Plast Reconstr Surg 93:44–53CrossRefPubMed Boyd JB, Morris S, Rosen IB, Gullane P, Rotstein L, Freeman JL (1994) The through-and-through oromandibular defect: rationale for aggressive reconstruction. Plast Reconstr Surg 93:44–53CrossRefPubMed
2.
go back to reference Petruzzelli GJ, Brockenbrough JM, Vandevender D, Creech SD (2002) The influence of reconstructive modality on cost of care in head and neck oncologic surgery. Arch Otolaryngol Head Neck Surg 128(12):1377–1380CrossRefPubMed Petruzzelli GJ, Brockenbrough JM, Vandevender D, Creech SD (2002) The influence of reconstructive modality on cost of care in head and neck oncologic surgery. Arch Otolaryngol Head Neck Surg 128(12):1377–1380CrossRefPubMed
3.
go back to reference Pickerell KL, Baker HM, Collins JP (1947) Reconstructive surgery of the chest wall. Surg Gynecol Obstet 84:465 Pickerell KL, Baker HM, Collins JP (1947) Reconstructive surgery of the chest wall. Surg Gynecol Obstet 84:465
4.
go back to reference Heuston JT, McConchie IH (1968) A compound pectoral flap. Aust N Z J Surg 38:61 Heuston JT, McConchie IH (1968) A compound pectoral flap. Aust N Z J Surg 38:61
5.
go back to reference Ariyan S (1979) The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck. Plast Reconstr Surg 63:73CrossRefPubMed Ariyan S (1979) The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck. Plast Reconstr Surg 63:73CrossRefPubMed
6.
go back to reference Bhathena HM, Kavrana NM (1989) The folded, bipaddled pectoralis major composite flap in oral reconstruction. Br J Plast Surg 42:441–446CrossRefPubMed Bhathena HM, Kavrana NM (1989) The folded, bipaddled pectoralis major composite flap in oral reconstruction. Br J Plast Surg 42:441–446CrossRefPubMed
7.
go back to reference Schuller DE (1980) Limitations of the pectoralis major myocutaneous flap in head and neck cancer reconstruction. Arch Otolaryngol 106:709CrossRefPubMed Schuller DE (1980) Limitations of the pectoralis major myocutaneous flap in head and neck cancer reconstruction. Arch Otolaryngol 106:709CrossRefPubMed
8.
go back to reference Shah JP (1980) Folded forehead flap for reconstruction of full-thickness defects of the cheek. Head Neck Surg 2:248–52.2CrossRefPubMed Shah JP (1980) Folded forehead flap for reconstruction of full-thickness defects of the cheek. Head Neck Surg 2:248–52.2CrossRefPubMed
9.
go back to reference Ord RA, Avery BS (1989) Side-by-side double paddle pectoralis major flap for cheek defects. Br J Oral Maxillofac Surg 27:177–185CrossRefPubMed Ord RA, Avery BS (1989) Side-by-side double paddle pectoralis major flap for cheek defects. Br J Oral Maxillofac Surg 27:177–185CrossRefPubMed
10.
go back to reference Jacob OJ (1994) One stage reconstruction of large oral mucocutaneous defects with double paddled pectoralis major myocutaneous flaps. Aust N Z J Surg 64:208–211CrossRefPubMed Jacob OJ (1994) One stage reconstruction of large oral mucocutaneous defects with double paddled pectoralis major myocutaneous flaps. Aust N Z J Surg 64:208–211CrossRefPubMed
11.
go back to reference Haers PE, IrE Griitz K, Sailer HE (1994) The bilobed myocutaneous pectoralis major flap in closure of combined intra- and extraoral defects. Int J Oral Maxillofac Surg 23:214–218CrossRefPubMed Haers PE, IrE Griitz K, Sailer HE (1994) The bilobed myocutaneous pectoralis major flap in closure of combined intra- and extraoral defects. Int J Oral Maxillofac Surg 23:214–218CrossRefPubMed
12.
go back to reference Deo SVS, Purkayastha J, Das DK et al (2003) Reconstruction of complex oral defects using bi-paddle pectoralis major flap—technical modifications and outcome in 54 cancer patients. Indian J Otolaryngol Head Neck Surg 55(1):5–9PubMedCentralPubMed Deo SVS, Purkayastha J, Das DK et al (2003) Reconstruction of complex oral defects using bi-paddle pectoralis major flap—technical modifications and outcome in 54 cancer patients. Indian J Otolaryngol Head Neck Surg 55(1):5–9PubMedCentralPubMed
13.
go back to reference Ahmad QG, Navadgi S, Agarwal R et al (2006) Bipaddle pectoralis major myocutaneous flap in reconstructing full thickness defects of cheek: a review of 47 cases. J Plast Reconstr Aesthet Surg 59:166–173CrossRefPubMed Ahmad QG, Navadgi S, Agarwal R et al (2006) Bipaddle pectoralis major myocutaneous flap in reconstructing full thickness defects of cheek: a review of 47 cases. J Plast Reconstr Aesthet Surg 59:166–173CrossRefPubMed
14.
go back to reference Rajacic N, Starovic B (1993) Reconstruction of full-thickness cheek defects with a bipaddled radial forearm flap. Br J Oral Maxillofac Surg 31:108–112CrossRefPubMed Rajacic N, Starovic B (1993) Reconstruction of full-thickness cheek defects with a bipaddled radial forearm flap. Br J Oral Maxillofac Surg 31:108–112CrossRefPubMed
15.
go back to reference Kang SH, Nam W, Cha IH et al (2009) Double continuous radial forearm flap for the reconstruction of full-thickness buccal cheek defect. J Plast Reconstr Aesthet Surg 62:e95–6.7CrossRefPubMed Kang SH, Nam W, Cha IH et al (2009) Double continuous radial forearm flap for the reconstruction of full-thickness buccal cheek defect. J Plast Reconstr Aesthet Surg 62:e95–6.7CrossRefPubMed
16.
go back to reference Chiu WK, Lin WC, Chen SY et al (2011) Computed tomography angiography imaging for the chimeric anterolateral thigh flap in reconstruction of full thickness buccal defect. ANZ J Surg 81:142–147CrossRefPubMed Chiu WK, Lin WC, Chen SY et al (2011) Computed tomography angiography imaging for the chimeric anterolateral thigh flap in reconstruction of full thickness buccal defect. ANZ J Surg 81:142–147CrossRefPubMed
17.
go back to reference Strasnick B, Calcaterra TC (1989) Reconstruction of full-thickness cheek defects with combined cervicopectoral and pectoralis major myocutaneous flaps. Laryngoscope 99:757–760CrossRefPubMed Strasnick B, Calcaterra TC (1989) Reconstruction of full-thickness cheek defects with combined cervicopectoral and pectoralis major myocutaneous flaps. Laryngoscope 99:757–760CrossRefPubMed
18.
go back to reference Gal TJ, Jones KA, Valentino J (2009) Reconstruction of the through-and-through oral cavity defect with the fibula free flap. Otolaryngol Head Neck Surg 140:519–525CrossRefPubMed Gal TJ, Jones KA, Valentino J (2009) Reconstruction of the through-and-through oral cavity defect with the fibula free flap. Otolaryngol Head Neck Surg 140:519–525CrossRefPubMed
19.
go back to reference Wilson JSP, Yiacoumettis AM, O’neill T (1984) Some observations on 112 pectoralis major myocutaneous flaps. Am J Surg 147(273):6 Wilson JSP, Yiacoumettis AM, O’neill T (1984) Some observations on 112 pectoralis major myocutaneous flaps. Am J Surg 147(273):6
20.
go back to reference Weaver AW, Vandenberg HJ, Atkinson DP, Wallace JR (1994) Modified bilobular (“gemini”) pectoralis major myocutaneous flap. Am J Surg 144:482–488CrossRef Weaver AW, Vandenberg HJ, Atkinson DP, Wallace JR (1994) Modified bilobular (“gemini”) pectoralis major myocutaneous flap. Am J Surg 144:482–488CrossRef
21.
go back to reference Shah JR, Haribhakti V, Loree TR, Sutaria P (1990) Complications of the pectoralis major myocutaneous flap in head and neck reconstruction. Am J Surg 160:352–355CrossRefPubMed Shah JR, Haribhakti V, Loree TR, Sutaria P (1990) Complications of the pectoralis major myocutaneous flap in head and neck reconstruction. Am J Surg 160:352–355CrossRefPubMed
Metadata
Title
Is there still a role for bilobed/bipaddled pectoralis major myocutaneous flap for single-stage immediate reconstruction of post ablative oncologic full-thickness defects of the cheek?
Authors
Nitin Bhola
Anendd Jadhav
Rajiv Borle
Gaurav Khemka
Sanatan Kumar
Harshit Shrivastava
Publication date
01-06-2015
Publisher
Springer Berlin Heidelberg
Published in
Oral and Maxillofacial Surgery / Issue 2/2015
Print ISSN: 1865-1550
Electronic ISSN: 1865-1569
DOI
https://doi.org/10.1007/s10006-014-0458-1

Other articles of this Issue 2/2015

Oral and Maxillofacial Surgery 2/2015 Go to the issue