Versatile, Bi-paddle Pectoralis Major Myocutaneous Flap in a High Risk Geriatric Male with Multiple Co-Morbidities, Presented with Advanced, Complex Oro-mandibular Cancer: A Case Report
Asian Oncology Research Journal,
Page 16-21
Abstract
The study reporting a case of a 78 year old elderly male patient with multiple co-morbidities with poor performance status with advanced oro-mandibular cancer who underwent oncological resection followed by reconstruction with bi-paddle PMMC flap as an alternative to micro-vascular free flap. Composite resection of the advanced or-mandibular cancer results in extensive defects which poses a challenge to the treating team as it will be difficult to restore mastication, speech and swallowing function. In head and neck cancers, free flaps have been used increasingly to cover the defect with the help of experienced and trained surgeons with fine skills of micro-vascular procedures. However , free flaps are not easily available at all centers in developing countries because of resource constraint, cost and expertise of surgeon. PMMC flap is the robust flap and it has been described and established since long in covering the both, intra and extra oral defects . With the help of random flap and multiple perforators, PMMC flap can mould into bi-lobed / bi-paddle / folded version which can cover intra-oral defect with covering of external lining. Bi-paddle PMMC flap is highly vascularized, versatile flap with short and easy learning curve and produces satisfactory aesthetic and functional results and should be considered as a first option in a geriatric patient with multiple co-morbidities.
Keywords:
- Oral cavity
- advanced oro-mandibular cancer
- versatile flap
- bi-paddle PMMC flap
- high risk geriatric
- surgeons
How to Cite
References
Wood JE. Reconstruction in head and neck cancer: a place for conservatism. Ann Plast Surg. 1987;18:209–211.
Urken ML, Weinberg H, Buchbinder D, et al. Microvascular free flaps in head and neck reconstruction. Arch Otolaryngol Head Neck Surg. 1994;120:633–640
Petruzzelli GJ, Brockenbrough JM, Vandevender D, Creech SD. The influence of reconstructive modality on cost of care in head and neck oncologic surgery. Arch Otolaryngol Head Neck Surg. 2002;128(12):1377–1380
Boyd JB, Morris S, Rosen IB, Gullane P, Rotstein L, Freeman JL. The through-and-through oromandibular defect: rationale for aggressive reconstruction. Plast Reconstr Surg. 1994;93(1):44–53.
Bhathena HM, Kavrana NM. The folded, bipaddled pectoralis major composite flap in oral reconstruction. Br J Plast Surg. 1989;42:441–446.
Freeman JL, Walker EP, Wilson JS, Shaw HJ. Te vascular anatomy of the pectoralis major myocutaneous flap. Br J Plast Surg. 1981;34:3–10.
Kroll SS, Evans GRD, Goldberg D et al (1997) A comparison of resource costs for head and neck reconstruction with free and pectoralis major flaps. Plast Reconstr Surg 99:1282–1286
Vartanian JG, Carvalho AL, Carvalho SM, Mizobe L, Magrin J, Kowalski LP. 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.
Funk GF, Karnell LH, Whitehead S, Paulino A, Ricks J, Smith RB. Free tissue transfer versus pedicled flap cost in head and neck cancer. Otolaryngol Head Neck Surg. 2002;127:205–212
Liu R, Gullane P, Brown D, Irish J. Pectoralis major myocutaneous pedicled flap in head and neck reconstruction: retrospective review of indications and results in 244 consecutive cases at the Toronto General Hospital. J Otolaryngol. 2001;30:34–40
Wilson JSP, Yiacoumettis AM, O’neill T. Some observations on 112 pectoralis major myocutaneous flaps. Am J Surg. 1984;147(273):6
Weaver AW, Vandenberg HJ, Atkinson DP, Wallace JR. Modified bilobular (‘‘gemini’’) pectoralis major myocutaneous flap. Am J Surg. 1994;144:482–488
Ahmad QG, Navadgi S, Agarwal R, et al. Bipaddle pectoralis major myocutaneous flap in reconstructing full thickness defects of cheek: a review of 47 cases. J Plast Reconstr Aesthet Surg. 2006;59:166–173.
Cunha-Gomes D, Chaudhary C, Kavarana NM. Vascular compromise of the pectoralis major mayocutaneous flap in head and neck reconstruction. Ann Plast Surge. 2003;51:450-4.
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