PECTORALIS MAJOR AND OTHER MYOFASCIAL/ MYOCUTANEOUS FLAPS IN HEAD AND NECK CANCER RECONSTRUCTION: EXPERIENCE WITH 437 CASES AT A SINGLE INSTITUTION

Abstract

Abstract: Background. Pectoralis major and other myofas-cial/myocutaneous flaps have been recognized as important reconstructive methods in head and neck cancer surgery. Even with the worldwide use of free flaps, they are still the mainstay reconstructive procedures in many centers. Methods. We retrospectively analyzed the records of pa-tients with head and neck cancer who underwent an immediate reconstruction with pectoralis major or other myofascial/myocu-taneous flaps at a tertiary cancer center from 1982 to 1998. Results. A total of 437 patients were reviewed. Three hun-dred seventy-one patients underwent pectoralis major myocuta-neous flaps; of these, 335 (90.3%) were men, with a median age of 56 years (range, 24–91 years). Tumors were located at the oral cavity and oropharynx in 246 patients (66.3%). Most tumors were at an advanced stage at presentation (T3–T4 in 60.9%). The flaps were used to cover mucosal defects in 280 patients (75.5%), skin defects in 62 patients (16.7%), and both in 29 pa-tients (7.8%). In most patients, the flap was transferred to the head and neck region through a subclavicular tunnel. The overall complication rate was 36.1%, with 2.4 % of cases involving total flap necrosis. Conclusion. To date, this is the largest published series of patients who underwent reconstruction with a pectoralis major flap. Our results show that this flap remains an important reconstructive method, and it can be done with low risk an