Indications and outcomes for 100 patients managed with a pectoralis major flap within a UK maxillofacial unit |
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| Institution: | 1. Department of Maxillofacial Surgery, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK;2. University of Birmingham, Birmingham, UK;3. Department of Clinical Oncology, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK;4. Department of Surgery, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK;1. Aide Odontologique Internationale, Paris, France;2. Faculty of Dentistry, University of Hong Kong, Hong Kong, China;3. West China College of Stomatology, Sichuan University, Chengdu, China;1. Vascular Mechanics Laboratory, Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA;2. Center for Health Engineering, University Hospital of Saint-Étienne, Saint-Étienne, France;3. Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA;1. Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands;2. Department of Fixed and Removable Prosthodontics, Dental School, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands;1. Department of HPB and Liver Transplant Surgery, Royal Free Hospital, London, UK;2. Research Department of Infection and Population Health, UCL, Royal Free Campus, UK;3. Department of HPB Surgery, Southampton General Hospital, Southampton, UK;4. Liver Unit, University Hospital Birmingham, Birmingham, UK;5. Department of HPB and Transplantation, Freeman Hospital, Newcastle, UK;6. Department of HPB and Liver Transplant Surgery, Royal Infirmary of Edinburgh, UK |
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| Abstract: | There are few studies reporting the role of the pedicled pectoralis major (PPM) flap in modern maxillofacial practice. The outcomes of 100 patients (102 flaps) managed between 1996 and 2012 in a UK maxillofacial unit that preferentially practices free tissue reconstruction are reported. The majority (88.2%) of PPM flaps were for oral squamous cell carcinoma (SCC), stage IV (75.6%) disease, and there was substantial co-morbidity (47.0% American Society of Anesthesiologists 3 or 4). The PPM flap was the preferred reconstruction on 80.4% of occasions; 19.6% followed free flap failure. Over half of the patients (57%) had previously undergone major surgery and/or chemoradiotherapy. Ischaemic heart disease (P = 0.028), diabetes mellitus (P = 0.040), and methicillin-resistant Staphylococcus aureus (MRSA) infection (P = 0.013) were independently associated with flap loss (any degree). Free flap failure was independently associated with total (2.0%) and major (6.9%) partial flap loss (P = 0.044). Cancer-specific 5-year survival for stage IV primary SCC and salvage surgery improved in the second half (2005–2012) of the study period (22.2% vs. 79.8%, P = 0.002, and 0% vs. 55.7%, P = 0.064, respectively). There were also declines in recurrent disease (P = 0.008), MRSA (P < 0.001), and duration of admission (P = 0.014). The PPM flap retains a valuable role in the management of advanced disease combined with substantial co-morbidity, and following free flap failure. |
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| Keywords: | pectoralis major flap co-morbidity complications survival mortality oral cancer |
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