Pulmonary function after pectoralis major myocutaneous flap harvest.
OBJECTIVE
The pectoralis major myocutaneous flap is widely used in the reconstruction of surgical defects in the head and neck region. Pulmonary atelectasis has been reported in patients undergoing these procedures, and many of these patients are heavy smokers and drinkers and have associated cardiopulmonary disorders. Flap harvest and donor site closure may lead to impairment of pulmonary function before and after the use of pectoralis major myocutaneous (PMC) in surgical reconstruction in patients with cancer of the head and neck.


METHODS
Patients undergoing extirpation of head and neck tumors with PMC reconstruction were prospectively evaluated. Patient age, smoking history (pack-years), anesthesia duration, percentage predicted pre- and postoperative FEV1, percentage-predicted pre- and postoperative FVC (forced vital capacity), and preoperative SaO2 (oxygen saturation) were evaluated. Preoperative FEV1/FVC ratio was calculated. Chest x-rays were reviewed.


RESULTS
Only 11 patients, 5 of whom smoked, could be evaluated postoperatively. Preoperative FEV1/FVC was more than 70 and FEV1 more than 75% predicted in all patients. A decrease in FVC was observed in 7 of the 11 patients, which ranged between 2% and 27% without any clinically obvious respiratory manifestations. A baseline SaO2 of more than 96% was noted in all patients. Four of 9 postoperative chest x-rays demonstrated atelectasis.


CONCLUSIONS
PMC harvest and donor site closure may lead to the recorded decrease in FVC measurements. These changes did not manifest clinically. Nevertheless, alternative methods of surgical defect closure should be considered in patients with severe preexisting pulmonary disorders.
Talmi
Yoav P
YP
Department of Otolaryngology--Head and Neck Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel. talmi@attglobal.net
Benzaray
Shlomo
S
Peleg
Michael
M
Eyal
Ana
A
Bedrin
Lev
L
Shoshani
Yitzhak
Y
Yahalom
Ran
R
Horowitz
Zeev
Z
Taicher
Shlomo
S
Kronenberg
Jona
J
Shiner
Robert J
RJ
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D001261:Pulmonary Atelectasis / Q000209:etiology*; D012129:Respiratory Function Tests; D013524:Surgical Flaps / Q000009:adverse effects*