Analysis of 120 Pectoralis Major Flaps for Head and Neck Reconstruction

Background A pectoralis major flap is one of the standard tools for the reconstruction of defects of the head and neck. Despite the technical advancement in free tissue transfer in head and neck reconstruction, the benefits of a pectoralis major flap should not be overlooked. The purpose of this study is to evaluate our 17 years of experience in reconstructing defects of the head and neck region using the pectoralis major flap.

Methods We retrospectively reviewed the medical records of 112 patients (120 cases) who underwent pectoralis major flap operations for head and neck reconstruction during a period ranging from 1994 to 2010.

Results In our series, no total necrosis of the flap occurred. Of the total cases, 30.8% presented with flap-related complications. Major complications occurred in 20% of all of the cases but were then all successfully treated. The male sex was correlated with the occurrence of overall complications (P=0.020) and major complications (P=0.007). Preoperative albumin levels of <3.8 g/dL were correlated with the formation of fistula (P=0.030). Defects of the hypopharynx were correlated with the occurrence of major complications (P=0.019) and the formation of fistula (P=0.012). Secondary reconstructions were correlated with the occurrence of overall complications (P=0.013) and the formation of fistula (P=0.030).

Conclusions A pectoralis major flap is still considered to be a safe, versatile one-stage reconstruction procedure in the management of the defects of head and neck and the protection of the carotid artery.

Keywords

Pedicled flap - Complications - Risk factors

This article was presented at the 68th Congress of the Korean Society of Plastic and Reconstructive Surgeons on Novermber 4-7, 2010 in Seoul, Korea.

Publication History

Received: 30 May 2012

Accepted: 01 August 2012

Article published online:
01 May 2022

• REFERENCES

• 1 Ariyan S. The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck. Plast Reconstr Surg 1979; 63: 73-81
• 2 Urken ML, Weinberg H, Buchbinder D. et al. Microvascular free flaps in head and neck reconstruction. Report of 200 cases and review of complications. Arch Otolaryngol Head Neck Surg 1994; 120: 633-640
• 3 Tsue TT, Desyatnikova SS, Deleyiannis FW. et al. Comparison of cost and function in reconstruction of the posterior oral cavity and oropharynx. Free vs pedicled soft tissue transfer. Arch Otolaryngol Head Neck Surg 1997; 123: 731-737
• 4 Chepeha DB, Annich G, Pynnonen MA. et al. Pectoralis major myocutaneous flap vs revascularized free tissue transfer: complications, gastrostomy tube dependence, and hospitalization. Arch Otolaryngol Head Neck Surg 2004; 130: 181-186
• 5 Koh KS, Eom JS, Kirk I. et al. Pectoralis major musculocutaneous flap in oropharyngeal reconstruction: revisited. Plast Reconstr Surg 2006; 118: 1145-1149
• 6 Baek SM, Lawson W, Biller HF. An analysis of 133 pectoralis major myocutaneous flaps. Plast Reconstr Surg 1982; 69: 460-469
• 7 Shah JP, Haribhakti V, Loree TR. et al. Complications of the pectoralis major myocutaneous flap in head and neck reconstruction. Am J Surg 1990; 160: 352-355
• 8 Kroll SS, Goepfert H, Jones M. et al. Analysis of complications in 168 pectoralis major myocutaneous flaps used for head and neck reconstruction. Ann Plast Surg 1990; 25: 93-97
• 9 Mehta S, Sarkar S, Kavarana N. et al. Complications of the pectoralis major myocutaneous flap in the oral cavity: a prospective evaluation of 220 cases. Plast Reconstr Surg 1996; 98: 31-37
• 10 IJsselstein CB, Hovius SE, ten Have BL. et al. Is the pectoralis myocutaneous flap in intraoral and oropharyngeal reconstruction outdated?. Am J Surg 1996; 172: 259-262
• 11 Vartanian JG, Carvalho AL, Carvalho SM. et al. Pectoralis major and other myofascial/myocutaneous flaps in head and neck cancer reconstruction: experience with 437 cases at a single institution. Head Neck 2004; 26: 1018-1023
• 12 Milenovic A, Virag M, Uglesic V. et al. The pectoralis major flap in head and neck reconstruction: first 500 patients. J Craniomaxillofac Surg 2006; 34: 340-343
• 13 Corten EM, Schellekens PP, Hage JJ. et al. Clinical outcome after pedicled segmental pectoralis major island flaps for head and neck reconstruction. Ann Plast Surg 2009; 63: 292-296
• 14 Pinto FR, Malena CR, Vanni CM. et al. Pectoralis major myocutaneous flaps for head and neck reconstruction: factors influencing occurrences of complications and the final outcome. Sao Paulo Med J 2010; 128: 336-341
• 15 McLean JN, Carlson GW, Losken A. The pectoralis major myocutaneous flap revisited: a reliable technique for head and neck reconstruction. Ann Plast Surg 2010; 64: 570-573