title: Pectoralis major myocutaneous flap for head and neck reconstruction: risk factors for fistula formation.
abstract: The pectoralis major myocutaneous flap (PMMF) is a safe and versatile flap used widely for head and neck cancer reconstructions, but one of the major and most feared complications is oro- or pharyngocutaneous fistula. Herein, we attempt to establish risk factors for fistula formation in reconstructions of mucosal defects in the head and neck using PMMF through retrospective analysis of PMMF performed during 3 years at a single institution, with a total of 84 procedures. There were 69 men and 15 women, with a mean age of 59.5 years. There were 15 cases of partial flap loss, two total flap losses and 31 fistulas. The independent risk factors for fistula formation were preoperative serum hemoglobin < 13 g/dl, preoperative serum albumin < 3.4 g/dl and hypopharynx reconstruction. The PMMF is still a very useful flap and this is the first multivariate analysis analysing risk factors for fistula formation. These findings are helpful in selecting patients with elevated risk of fistula formation, and therefore preventive measures can be undertaken to avoid potentially serious complications.
authors.affiliation: Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil;
authors.forename: A K N
authors.initials: AK
authors.lastname: Leite
authors.affiliation: Department of Head and Neck Surgery, Instituto do Câncer do Estado de São Paulo (ICESP), University of São Paulo Medical School.
authors.forename: L L
authors.initials: LL
authors.lastname: de Matos
authors.affiliation: Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil;
authors.forename: M
authors.initials: M
authors.lastname: Belli
authors.affiliation: Department of Head and Neck Surgery, Instituto do Câncer do Estado de São Paulo (ICESP), University of São Paulo Medical School.
authors.forename: M A V
authors.initials: MA
authors.lastname: Kulcsar
authors.affiliation: Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil;
authors.forename: C R
authors.initials: CR
authors.lastname: Cernea
authors.affiliation: Department of Head and Neck Surgery, Instituto do Câncer do Estado de São Paulo (ICESP), University of São Paulo Medical School.
authors.forename: L
authors.initials: L
authors.lastname: Garcia Brandão
authors.affiliation: Department of Head and Neck Surgery, Instituto do Câncer do Estado de São Paulo (ICESP), University of São Paulo Medical School.
authors.forename: F R
authors.initials: FR
authors.lastname: Pinto
mesh_terms: D000368:Aged; D017577:Cutaneous Fistula / Q000453:epidemiology*; D005260:Female; D005402:Fistula / Q000453:epidemiology*; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D064827:Myocutaneous Flap; D016155:Oral Fistula / Q000453:epidemiology*; D010369:Pectoralis Muscles / Q000637:transplantation; D010608:Pharyngeal Diseases / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Fistula; Head and neck Neoplasms; Pectoralis muscle; Reconstructive surgical procedures