Enhanced morbidity of pectoralis major myocutaneous flap used for salvage after previously failed oncological treatment and unsuccessful reconstructive head and neck surgery.
BACKGROUND
The reconstruction of complex cervicofacial defects arising from surgical treatment for cancer is a real challenge for head and neck surgeons, especially in salvage reconstruction surgery and/or failed previous reconstruction. The pectoralis major myocutaneous flap (PMMF) has been widely used in these specific situations due to its reliability and low rate of failure or complications.


OBJECTIVE
Identify factors that determine complications and influence the final outcome of the reconstructions with PMMF in salvage cancer surgery or in salvage reconstruction.


METHODS
A cross-sectional study design was used to evaluate a sample including 17 surgical patients treated over a period of ten years that met the inclusion criteria.


RESULTS
Reconstruction was successful in 13 cases (76.5%), with two cases of partial flap loss and no case of total loss. Complications occurred in 13 cases (76.5%) and were specifically related to the flap in nine instances (52.9%). An association was identified between the development of major complications and reconstruction of the hypopharynx (P = 0.013) as well as in patients submitted to surgery in association with radiation therapy as a previous cancer treatment (P = 0.002). The former condition is also associated with major reconstruction failure (P = 0.018). An even lower incidence of major complications was noted in patients under the age of 53 (P = 0.044).


CONCLUSIONS
Older patients, with hypopharyngeal defects and submitted to previous surgery plus radiation therapy, presented a higher risk of complications and reconstruction failure with PMMF.
Department of Head and Neck Surgery, ABC Medical School, São Paulo, Brazil.
Christiana Maria
CM
Ribeiro Salles Vanni
Leandro Luongo
LL
de Matos
Mário Paulo
MP
Faro Junior
Jossi
J
Ledo Kanda
Cláudio Roberto
CR
Cernea
Lenine
L
Garcia Brandão
Fábio Roberto
FR
Pinto
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery*; D003430:Cross-Sectional Studies; D006257:Head / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000379:methods; D008875:Middle Aged; D009017:Morbidity; D010369:Pectoralis Muscles / Q000601:surgery* / Q000637:transplantation; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D015203:Reproducibility of Results; D016879:Salvage Therapy / Q000379:methods; D013524:Surgical Flaps; D016896:Treatment Outcome