Does Pectoralis Major Myocutaneous Flap Cause the Shoulder Morbidity: A Clinical Comparative Study
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ORIGINAL ARTICLE
Does Pectoralis Major Myocutaneous Flap Cause the Shoulder Morbidity: A Clinical Comparative Study Venkatesh Anehosur1 • Hitesh Vadera2 • Adithi Bhat3 • S. Satyanarayana4 Niranjan Kumar5
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Received: 3 October 2020 / Accepted: 10 November 2020 Ó Association of Otolaryngologists of India 2020
Abstract The aim was to compare the morbidity of shoulder function following modified radical neck dissection with and without Pectoralis Major Myocutaneous muscle flap (PMMC) harvest in head and neck cancer patient to determine the effect of PMMC flap harvest on shoulder function and also to determine the effect of physiotherapy. Materials and methods: Prospective study involving two groups study group of 20 patients with MRND, with PMMC flap reconstruction as part of head and neck cancer surgery and control group of 20 patients who had undergone MRND(IJV & SAN sparing) without & Venkatesh Anehosur [email protected] Hitesh Vadera [email protected] Adithi Bhat [email protected] S. Satyanarayana [email protected] Niranjan Kumar [email protected] 1
SDM Craniofacial Surgery and Research Centre, SDM College of Dental Science and Hospital, Shri Dharmasthala Manjunatheshwar University, Dharwad, Karnataka, India
2
Department of Oral and Maxillofacial Surgery, AMC Dental College Khokhara, Ahmedabad, India
3
SDM College of Dental Sciences and Hospital Shri Dharmasthala Manjunatheshwar University, Dharwad, Karnataka, India
4
Sumedh Physiotherapy Centre, Hubli, Karnataka, India
5
Department of Plastic and Reconstructive Surgery, SDM Craniofacial Centre, Shri Dharmasthala Manjunatheshwar University, SDM College of Medical Sciences and Hospital, Sattur, Dharwad, Karnataka 580009, India
PMMC flap in same period were included. All patients were assessed at 3rd and 6th month following completion of surgery using subjective (Shoulder Disability Questionnaire) and objective (goniometer and manual muscle testing) parameters. 40 patients were included in the study, 33 (82.5%) male and 7 (17.5%) female with a mean age of 49 years with stage III/IV carcinoma In Group-1 and Group-2 the shoulder disability decreased significantly after physiotherapy intervention and also at 6thmonth postoperatively both groups showed improvements in shoulder range of motion and muscle strength. Harvesting of PMMC flap does not intensify the morbidity of shoulder which is common in RND and during MRND. A regimen of home-based exercises and patient education are effective tools to reduce shoulder disability and improving shoulder function. Keywords Shoulder morbidity Modified radical neck dissection pectoralis major myocutaneous flap Range of motion Goniometer Manual muscle test Physiotherapy
Introduction The Pectoralis Major Myocutaneous muscle flap has been the most commonly used pedicle flap in major head and neck cancer surgery and remains the ‘‘workhorse flap’’ for head and neck reconstruction [1]. Its advantages are reliability, speed and ease of harvest, rich vascularity, bulk a
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