Combined Use of Pectoralis Major Myocutaneous Flap and Deltopectoral Flap for the Reconstruction of Advanced Oral Cancer
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ORIGINAL ARTICLE
Combined Use of Pectoralis Major Myocutaneous Flap and Deltopectoral Flap for the Reconstruction of Advanced Oral Cancers: Our Experience in 29 Cases Pradeep Pradhan1 • Chappity Preetam1 • Sourav Sarkar1 • Dillip Kumar Samal1 Pradipta Kumar Parida1
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Received: 15 April 2020 / Accepted: 6 October 2020 Ó The Association of Oral and Maxillofacial Surgeons of India 2020
Abstract Purpose To assess the utility of the combined use of pectoralis major myocutaneous (PMMC) flap and deltopectoral flap (DP) in advanced oral cavity cancers in the Indian population. Materials and Methods It is a retrospective study, considering 29 patients with stage IV carcinoma of the oral cavity, from July 2015 to February 2019. Both pectoralis major Myocutaneous flaps and deltopectoral flaps were used for stage IV oral cancers involving the full-thickness cheek and the mandibular cortex. The reliability of the flaps and clinical outcomes were evaluated in the postoperative period. Results Of the 29 patients, partial necrosis of the skin island was detected in 6 patients, 2 patients presented with wound dehiscence, and one patient had an orocutaneous fistula. Recurrence was detected in 3(10.34%) patients, in one patient, it was at the primary site and in 2 patients, it was in the neck. When different parameters were compared between the patients with complications and without complications, the comorbidities like smoking and alcohol intake adversely affected the flap survival in the postoperative period. Conclusions The combined use of PMMC and DP flap can be a reliable option for advanced oral malignancies, especially in patients with poor performance status with the coexisting chronic illness. Due to the presence of a definite vascular pedicle, ease of harvesting the flap, quick surgical procedure, and the minimal postoperative morbidities, & Pradeep Pradhan [email protected] 1
Department of Otorhinolaryngology, All India Institute of Medical Sciences, Bhubaneswar, Odisha 751019, India
these pedicle flaps can be successfully used alternative to the free flaps in advanced oral cancers, especially patients with a low socioeconomic corridor like India. Keywords Pectoralis major myocutaneous flap Deltopectoral flap Oral malignancy Outcomes
Introduction Malignancy of the oral cavity is the commonest among all malignancies affecting the head and neck region, accounting for 20 per 100,000 population and approximately 60–80% of cases present at an advanced stage [1] and it is the leading cause of mortality among the head neck cancers [2, 3]. It is mostly due to the addiction to tobacco either by chewing or placing it in the sulcus for a longer time. As a tertiary care referral hospital, the majority of our patients get referred from a secondary hospital. Hence it is always a challenge for the soft tissue reconstruction in these patients as significant proportion patients present at the late stage of the disease. Again, the financial condition of the patients, the nutrition status, and the presence of comorbidites
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