Bilobed PMMC in Females: Our Challenging yet Meritorious Experience
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ORIGINAL ARTICLE
Bilobed PMMC in Females: Our Challenging yet Meritorious Experience Dipin Jayaprakash 1 & Kunal Nandy 1 & Umank Tripathi 1 & Mohamad Taher Mithi 1 & Ronak Vyas 1 & Sudam Sadangi 1 Received: 7 April 2020 / Accepted: 15 September 2020 # Indian Association of Surgical Oncology 2020
Abstract The gold standard reconstructive options for full-thickness defect of the oral cavity after resection of malignant lesions are the free flaps. But in developing nations due to resource constraints, it cannot be offered to all. Hence, pectoralis major myocutaneous (PMMC) flap as bilobed flaps is most commonly used. Bilobed flaps are technically demanding, and in females, it is more challenging due to higher complication rates especially in large breasts. There has been no major reported data evaluating outcomes of bilobed PMMC in females. This is a retrospective evaluation of outcomes of patients who underwent the bilobed PMMC flap reconstruction for fullthickness defect of the oral cavity after resection of malignant lesions from June 2018 to December 2019. Out of 80 patients, all patients ultimately had adequate tissue coverage for the defect with acceptable facial aesthetics. Functional outcomes with regards to oral continence, speech and swallowing were encouraging. Our study had 33.75% flap-related complications. Fifteen percent of patients developed varying degrees of flap loss, of which only 3.75% had total flap loss and 11.25% had partial flap loss which was managed accordingly. Our study concludes that with careful planning, raising of flap based on sound anatomic concepts and applying oncoplastic techniques, shortcomings of bilobed female PMMC can be addressed and still used as suitable alternatives for free flap for full-thickness oral cavity defects in limited resource settings. Keywords Female bilobed PMMC . Surgical technique bilobed PMMC . Pectoralis major myocutaneous flap . Bipaddled/bilobed PMMC . Surgical technique PMMC
Reconstruction of full-thickness defects of the oral cavity after extensive resection for malignant lesions is technically cumbersome. Any adverse events after reconstruction affect wound healing, which delays the adjuvant treatment thus hampering the oncological outcomes and it also affects functions like speech and swallowing. The gold standard in reconstructive option for oral cavity defects is the free flap. Unfortunately, in most developing nations due to resource constraints pedicled flaps, especially the pectoralis major myocutaneous (PMMC) flaps are used [1]. Full-thickness defects in the oral cavity mandate the need for technically challenging bilobed PMMC flaps. In females, it is even more challenging because of substantial breast tissue
* Umank Tripathi [email protected] 1
Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
between the skin-paddle and the muscle, hence increasing the chances of skin-paddle loss [2]. To reduce the same, we try to limit the entire skin paddle over the muscle, which can caus
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