Pectoralis Major Myocutaneous Flap in the Reconstructive Surgery of the Head and Neck – Our Experience

The goal of this retrospective study is the evaluation of pectoralis major myocutaneous pedicle flap (PMMPF) reliability in clinical practice based on the analysis of the leading indication and postoperative complications. In the period from 2005 to 2011 at the University Department of Otorhinolaryngology and Head and Neck Surgery, Zagreb University Hospital Center, a total number of 27 PMMPF were used in the treatment of 26 patients. Indications for flap use were upper aerodigestive tract and soft tissue defects following resection of head and neck cancer. One-stage reconstructive technique was used in all patients. Basic demographic data, clinical stage of malignant disease, indications, postoperative complications and management of flap-related complications were systematically analyzed. In 24 cases (89%) leading indication for flap use was primary defect reconstruction following head and neck carcinoma resection and in 3 cases (11%) »salvage« reconstruction following salivary fistula formation and flap-related complications. Tumor invaded skin in 2 (8%) cases, oral cavity in 1 (4%) case, oropharynx in 12 (46%) cases, larynx and/or hypopharynx in 10 (38%) cases and major salivary gland in 1 case (4%). Mucous defect occurred in 21 (81%), cutaneous defect in 3 (11%) and muco-cutaneous defect in 2 patients (8%), respectively. 16 postoperative complications (59.3%) were recorded but only one patient (4%) sustained total flap necrosis. Previously irradiated patients had significantly higher postoperative complication rate. The rate of complications requiring surgical treatment was 25%. Although the overall complication rate was substantially high, PMMPF achieved desired reconstructive goal in 96% cases. Functional and aesthetic assessment was difficult due to the small series of patients. In conclusion, pectoralis major myocutaneous pedicle flap is still safe and acceptable reconstructive method in surgical treatment of patients with head and neck tumors