Pectoralis major and other myofascial/myocutaneous flaps in head and neck cancer reconstruction: Experience with 437 cases at a single institution

• Published in: Head & neck 2004-12, Vol.26 (12), p.1018-1023
• Main Authors: Vartanian, José Guilherme, Carvalho, André Lopes, Carvalho, Solange Maria T., Mizobe, Lia, Magrin, José, Kowalski, Luiz Paulo
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cohort Studies; complications; Esthetics; Female; Follow-Up Studies; Graft Rejection; Graft Survival; head and neck neoplasms; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - surgery; head and neck reconstruction; Humans; Male; Medical sciences; Middle Aged; Neck Dissection - adverse effects; Neck Dissection - methods; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; pectoralis major myocutaneous flap; Pectoralis Muscles - transplantation; pedicled flap; Postoperative Complications; Probability; Reconstructive Surgical Procedures - adverse effects; Reconstructive Surgical Procedures - methods; Retrospective Studies; Risk Assessment; Skin Transplantation - adverse effects; Skin Transplantation - methods; Surgical Flaps; Tumors; Wound Healing
• ISSN: 1043-3074; 1097-0347
• DOI: 10.1002/hed.20101

Background. Pectoralis major and other myofascial/myocutaneous flaps have been recognized as important reconstructive methods in head and neck cancer surgery. Even with the worldwide use of free flaps, they are still the mainstay reconstructive procedures in many centers. Methods. We retrospectively analyzed the records of patients with head and neck cancer who underwent an immediate reconstruction with pectoralis major or other myofascial/myocutaneous flaps at a tertiary cancer center from 1982 to 1998. Results. A total of 437 patients were reviewed. Three hundred seventy‐one patients underwent pectoralis major myocutaneous flaps; of these, 335 (90.3%) were men, with a median age of 56 years (range, 24–91 years). Tumors were located at the oral cavity and oropharynx in 246 patients (66.3%). Most tumors were at an advanced stage at presentation (T3–T4 in 60.9%). The flaps were used to cover mucosal defects in 280 patients (75.5%), skin defects in 62 patients (16.7%), and both in 29 patients (7.8%). In most patients, the flap was transferred to the head and neck region through a subclavicular tunnel. The overall complication rate was 36.1%, with 2.4% of cases involving total flap necrosis. Conclusion. To date, this is the largest published series of patients who underwent reconstruction with a pectoralis major flap. Our results show that this flap remains an important reconstructive method, and it can be done with low risk and acceptable morbidity. © 2004 Wiley Periodicals, Inc. Head Neck 26: 1018–1023, 2004