Defect–oriented reconstruction for advanced Head and Neck malignancy using Pectoralis Major Myocutaneous flap variations- Our experience in 7 case scenarios

Introduction: Head and neck cancers (HNCs) are the most common cancers in the world with India leading in the number of cases. Considering the vast majority of morbidity and mortality associated with HNC, proper planning & execution is needed to achieve best cosmetic & functional outcome. The reconstruction of such large complex defects which has extensive loss of mucosa, bone, soft tissue & skin is a challenge. Aims and objectives: To highlight the utility of different ways of Pectoralis Major Myocutaneous Flap [PMMC] reconstruction in advanced head and neck cancer at a single rural cancer hospital in western India. Material and methods: In seven patients, Pectoralis major myocutaneous flap (PMMC) was used for reconstruction for various defects. Complications were noted post operatively. Results: Single paddle PMMC flap, Spiral PMMC flap was used in 2 patients each, Bipaddle PMMC flap, Tube PMMC flap and contralateral PMMC flap was used in 1 patient each. No major complications were found post-operatively. Amongst minor complications, one patient had seroma formation beneath the flap, one had suture dehiscence and one patient had peripheral partial necrosis and all were managed conservatively with good results. Conclusion: The pectoralis major flap is a reliable option for primary and secondary soft tissue reconstruction in the head and neck surgeries. Due to abundant vasculature, less donor and recipient mortality and morbidity, PMMC continues to be the safe option for surgical reconstruction in head and neck cancer patients