Pedicled Latissimus Dorsi Myocutaneous Flap-an Effective Reconstructive Option for Extensive Buccal Cancer Resection in
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ORIGINAL ARTICLE
Pedicled Latissimus Dorsi Myocutaneous Flap-an Effective Reconstructive Option for Extensive Buccal Cancer Resection in Resource Constrained and Salvage Settings Swagnik Chakrabarti 1 & Achyuth Panuganti 1 & Monika Gupta 1 & Abhishek Ghosh 1 & Sandeep Bhukar 1 & Tanvi Choubey 1 & Aseem Mishra 1 & Sudhendhu Shekhar Sharma 1 Received: 12 December 2019 / Accepted: 2 June 2020 # Indian Association of Surgical Oncology 2020
Abstract Free flaps are the gold standard for reconstruction of extensive buccal cancer resections. However, salvage surgeries in previously operated and radiated necks, cost, increased operating time, and patient co-morbidities limit their routine use in high volume and resource-constrained settings. Pectoralis major myocutaneous (PMMC) flap is the mainstay of reconstruction of large buccal defects. However, reconstruction becomes a challenge during salvage of recurrences where PMMC has been utilized in previous reconstruction and in female patients where PMMC harvest results in major donor site morbidity. A retrospective analysis of clinical data of 13 consecutive patients (eight male and five female) with through and through buccal cancer resection defects reconstructed using pedicled latissimus dorsi (LD) flap from July 2018 to September 2019 was performed. The indications of using an LD flap were salvage surgeries for recurrences where PMMC was used in earlier reconstruction, medical co-morbidities, vessel depleted necks, and financial constraints precluding use of free flaps. The mean follow-up period was 9.84 months. The mean operating time post-resection was 2 h and 26 min. The mean hospital stay was 12.61 days. All patients could be decannulated successfully (mean duration 9.69 days) and 12 could be weaned off feeding tube. None of the patients had any major flap related or donor site complications. Pedicled LD flap has a limited but an effective reconstructive role for extensive buccal cancer ablation as an alternative to free flaps and PMMC in salvage and resource-constrained situations. Keywords Pedicled latissimus dorsi flap . PMMC flap . Free flap . Salvage surgery . Female patients . Resource-constrained situations
Introduction Composite post-ablative buccal cancer defects are reconstructive challenges. Free flaps are considered gold standard for reconstruction of complex-advanced oral cancers. [1] They are not only more pliable and compliant as compared to pedicled flaps, but also reserve the option of using pedicled flap reconstruction in cases of salvageable recurrent or second primary cancers, where using a second free flaps can be difficult in vessel depleted and post radiated necks. However, prolonged operating time, patient co-morbidities, cost, high patient volume, and resource constraints [2] are the major limitations of using free flaps
* Swagnik Chakrabarti [email protected] 1
Homi Bhabha Cancer Hospital, Varanasi, India
especially in India with a heavy burden of oral cancers and poor socio-economic patient profile. In such scenarios, loco regional
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