Top

European Archives of Oto-Rhino-Laryngology

Published in:

01-11-2015 | Head and Neck

Risk factors of recipient site infection in head and neck cancer patients undergoing pectoralis major myocutaneous flap reconstruction

Authors: Chao-Hsien Wang, Yong-Kie Wong, Ching-Ping Wang, Chen-Chi Wang, Rong-San Jiang, Chih-Sheng Lai, Shih-An Liu

Published in: European Archives of Oto-Rhino-Laryngology | Issue 11/2015

Abstract

The aim of this study was to investigate the factors associated with infection at the recipient site of pectoralis major myocutaneous flap (PMMF) of head and neck cancer patients. We retrospectively reviewed head and neck cancer patients who underwent PMMF reconstruction and identified those with recipient site infection. Variables of patients with and without infection were compared and associated factors were investigated by logistic regression model. A total of 478 patients were included in the final analysis and 183 patients (38.3 %) developed recipient site infection. Lower margin of skin island, concurrent tracheotomy, diabetes mellitus, mandibular plate reconstruction, prior radiation, and peri-operative blood transfusion were independent factors associated with recipient site infection of PMMF. Skin island of PMMF beyond the eighth intercostal space markedly increased the risk of recipient site infection after major head and neck cancer surgery. Recognition of relevant factors associated with infection may help surgeons to identify those at risk.

Hsing CY, Wong YK, Wang CP, Wang CC, Jiang RS, Chen FJ et al (2011) Comparison between free flap and pectoralis major pedicled flap for reconstruction in oral cavity cancer patients—a quality of life analysis. Oral Oncol 47:522–527CrossRefPubMed

Liu R, Gullane P, Brown D, Irish J (2001) 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 30:34–40CrossRefPubMed

McLean JN, Carlson GW, Losken A (2010) The pectoralis major myocutaneous flap revisited: a reliable technique for head and neck reconstruction. Ann Plast Surg 64:570–573PubMed

Vartanian JG, Carvalho AL, Carvalho SM, Mizobe L, Magrin J, Kowalski LP (2004) Pectoralis major and other myofascial/myocutaneous flaps in head and neck cancer reconstruction: experience with 437 cases at a single institution. Head Neck 26:1018–1023CrossRefPubMed

Shah JP, 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

Chaturvedi P, Pathak KA, Pai PS, Chaukar DA, Deshpande MS, D’Cruz AK (2004) A novel technique of raising a pectoralis major myocutaneous flap through the skin paddle incision alone. J Surg Oncol 86:105–106CrossRefPubMed

Milenović A, Virag M, Uglesić V, Aljinović-Ratković N (2006) The pectoralis major flap in head and neck reconstruction: first 500 patients. J Craniomaxillofac Surg 34:340–343CrossRefPubMed

Ramakrishnan VR, Yao W, Campana JP (2009) Improved skin paddle survival in pectoralis major myocutaneous flap reconstruction of head and neck defects. Arch Facial Plast Surg 11:306–310CrossRefPubMed

Pinto FR, Malena CR, Vanni CM, Capelli Fde A, Matos LL, Kanda JL (2010) Pectoralis major myocutaneous flaps for head and neck reconstruction: factors influencing occurrences of complications and the final outcome. Sao Paulo Med J 128:336–341CrossRefPubMed

10.

Chepeha DB, Annich G, Pynnonen MA, Beck J, Wolf GT, Teknos TN et al (2004) Pectoralis major myocutaneous flap vs revascularized free tissue transfer: complications, gastrostomy tube dependence, and hospitalization. Arch Otolaryngol Head Neck Surg 130:181–186CrossRefPubMed

11.

Jsselstein CB, Hovius SE, ten Have BL, Wijthoff SJ, Sonneveld GJ, Meeuwis CA et al (1996) Is the pectoralis myocutaneous flap in intraoral and oropharyngeal reconstruction outdated? Am J Surg 172:259–262CrossRef

12.

Johnson JT, Myers EN, Thearle PB, Sigler BA, Schramm VL Jr (1984) Antimicrobial prophylaxis for contaminated head and neck surgery. Laryngoscope 94:46–51CrossRefPubMed

13.

Rikimaru H, Kiyokawa K, Inoue Y, Tai Y (2005) Three-dimensional anatomical vascular distribution in the pectoralis major myocutaneous flap. Plast Reconstr Surg 115:1342–1352 (discussion 1353–1354)CrossRefPubMed

14.

Rikimaru H, Kiyokawa K, Watanabe K, Koga N, Nishi Y, Sakamoto A (2009) New method of preparing a pectoralis major myocutaneous flap with a skin paddle that includes the third intercostal perforating branch of the internal thoracic artery. Plast Reconstr Surg 123:1220–1228CrossRefPubMed

15.

Po-Wing Yuen A (2006) Preservation of lateral thoracic artery to improve vascular supply of distal skin without compromising pedicle length in harvesting pectoralis major myocutaneous flap. J Plast Reconstr Aesthet Surg 59:1433–1435CrossRefPubMed

16.

Schneider DS, Wu V, Wax MK (2012) Indications for pedicled pectoralis major flap in a free tissue transfer practice. Head Neck 34:1106–1110CrossRefPubMed

17.

Lee DH, Kim SY, Nam SY, Choi SH, Choi JW, Roh JL (2011) Risk factors of surgical site infection in patients undergoing major oncological surgery for head and neck cancer. Oral Oncol 47:528–531CrossRefPubMed

18.

Liu SA, Wong YK, Poon CK, Wang CC, Wang CP, Tung KC (2007) Risk factors for wound infection after surgery in primary oral cavity cancer patients. Laryngoscope 117:166–171CrossRefPubMed

Title: Risk factors of recipient site infection in head and neck cancer patients undergoing pectoralis major myocutaneous flap reconstruction
Authors: Chao-Hsien Wang
Yong-Kie Wong
Ching-Ping Wang
Chen-Chi Wang
Rong-San Jiang
Chih-Sheng Lai
Shih-An Liu
Publication date: 01-11-2015
Publisher: Springer Berlin Heidelberg
Published in: European Archives of Oto-Rhino-Laryngology / Issue 11/2015
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-014-3372-0

At a glance: The STEP trials

Springer Medicine

Risk factors of recipient site infection in head and neck cancer patients undergoing pectoralis major myocutaneous flap reconstruction

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 11/2015

Corticosteroid treatment of idiopathic sudden sensorineural hearing loss: analysis of an RCT and material drawn from the Swedish national database

Squamous cell carcinoma of the lip: survival analysis with long-term follow-up

Speech and language development after cochlear implantation in children with bony labyrinth malformations: long-term results

Vestibular-evoked myogenic potentials and subjective visual vertical testing in patients with vitamin D deficiency/insufficiency

Early and long-term morbidity after minimally invasive total laryngo-pharyngo-esophagectomy with gastric pull-up reconstruction via thoracoscopy, laparoscopy and cervical incision

Acquisition of diagnostic and surgical skills in otorhinolaryngology: a comparison of France and Germany