BACKGROUND: The benefits and superiority of free flaps for head and neck reconstruction are well recognized. However, in some instances, especially in elderly and critical patients with advanced intraoral and oropharyngeal cancers or in patients with underlying systemic syndromes (i.e. uncontrolled diabetes, cardio-pulmonary failure, renal insufficiency), the use of pectoralis mayor myocutaneous flap may be a preferable option with fewer risks for the patient. PATIENTS AND METHODS: We present a series of 12 pectoralis major myocutaneous flaps, performed from January 2007 to June 2008, in 12 critical patients who presented with advanced carcinomas of the oral cavity and oropharynx. In all cases, histology showed (T3-T4)-(N0-N3)-M0 squamous cell carcinomas. Tumors were: 4 intraoral (33%), 2 in the oropharynx (16%), 5 in the hypopharynx (41%) and 1 of the skin left auricle (8%). RESULTS: There were no flap loss. Partial skin necrosis (<10%) occurred in 1 case (8%); one patient (8%) developed wound infection treated successfully with systemic antibiotic therapy. Minor oro cutaneous fistulas developed in 2 patients (16%). At the follow-up 4 patients (34%) died after 4 months, 2 patients (16%) had recurrence of disease, 6 patients (50%) showed no evidence of disease. CONCLUSION: The use of pectoralis major myocutaneous flap as a salvage procedure in immediate reconstruction following ablative surgery of head and neck cancers is still a valid alternative procedure to free tissue transfer. Because of reduced operative times, reduced anaesthetic risk, reduced risk of total flap necrosis and reduced costs, it could be considered as a preferable choice in selected cases.
BACKGROUND: The benefits and superiority of free flaps for head and neck reconstruction are well recognized. However, in some instances, especially in elderly and critical patients with advanced intraoral and oropharyngeal cancers or in patients with underlying systemic syndromes (i.e. uncontrolled diabetes, cardio-pulmonary failure, renal insufficiency), the use of pectoralis mayor myocutaneous flap may be a preferable option with fewer risks for the patient. PATIENTS AND METHODS: We present a series of 12 pectoralis major myocutaneous flaps, performed from January 2007 to June 2008, in 12 critical patients who presented with advanced carcinomas of the oral cavity and oropharynx. In all cases, histology showed (T3-T4)-(N0-N3)-M0 squamous cell carcinomas. Tumors were: 4 intraoral (33%), 2 in the oropharynx (16%), 5 in the hypopharynx (41%) and 1 of the skin left auricle (8%). RESULTS: There were no flap loss. Partial skin necrosis (<10%) occurred in 1 case (8%); one patient (8%) developed wound infection treated successfully with systemic antibiotic therapy. Minor oro cutaneous fistulas developed in 2 patients (16%). At the follow-up 4 patients (34%) died after 4 months, 2 patients (16%) had recurrence of disease, 6 patients (50%) showed no evidence of disease. CONCLUSION: The use of pectoralis major myocutaneous flap as a salvage procedure in immediate reconstruction following ablative surgery of head and neck cancers is still a valid alternative procedure to free tissue transfer. Because of reduced operative times, reduced anaesthetic risk, reduced risk of total flap necrosis and reduced costs, it could be considered as a preferable choice in selected cases.