BIPADDLED SPLIT PECTORALIS MAJOR MYOCUTANEOUS FLAPS FOR IMMEDIATE RECONSTRUCTION OF ORAL MUCOSAL DEFECTS AND NECK DEFECTS AFTER RESECTION OF RECURRENT ORAL CANCER_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHENJie ¹ ,  JIANGCanhua ¹ , LINing ¹ , GAOZhengyang ¹ , CHENLichun ² , WUXiaoshan ¹ , CHENXinqun ¹ , JIANXinchun ¹

1. Department of Oral and Maxillofacial Surgery Xiangya Hospital, Central South University, Changsha Hunan, 410008, P. R. China;
2. Department of Operation Room, Xiangya Hospital, Central South University, Changsha Hunan, 410008, P. R. China;

Corresponding author：

JIANGCanhua, Email: canhua-j@sohu.com

Keywords：

Split pectoralis major myocutaneous flap; Recurrent oral cancer; Defect repair; Local flap

DOI：

10.7507/1002-1892.20150172

Video：

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Objective To investigate the feasibility of the bipaddled split pectoralis major myocutaneous flap for immediate reconstruction of oral mucosal defects and neck defects after resection of recurrent oral cancer. Methods Six patients with oral mucosal defects combined with neck defects after recurrent oral cancer resection were treated with bipaddled split pectoralis major myocutaneous flap between September 2013 and September 2014. There were 5 males and 1 female with an average age of 54.7 years (range, 45-62 years), including 4 cases of recurrent tongue cancer, 1 case of recurrent mandibular gingival cancer, and 1 case of mouth floor carcinoma. All patients underwent local recurrence at 8 to 14 months after first operation, with no distant metastasis. The defects of the intraoral mucosa was 4.0 cm×2.5 cm to 6.5 cm×3.5 cm and the defect of the neck skin was 5.5 cm×3.5 cm to 7.5 cm×5.0 cm. The pectoralis major myocutaneous flaps (14.0 cm×3.5 cm to 17.0 cm×5.5 cm) were incised at the level of the 3rd to the 4th rib, and then split down along the muscle fiber till about 2 cm away from the thoracoacromial vessels, forming 2 independent skin paddles with 1-2 branch vessels to the pedicles of the distal ones. The distal skin paddles were used for oral reconstruction while the proximal paddles for repair of neck defects. The chest donor sites were sutured directly. Results Cervical haematoma and infection happened in 1 patient respectively after operation, and were cured after symptomatic treatment. All 6 split pectoralis major myocutaneous flaps with 12 skin paddles completely survived. All patients were followed up 6 to 18 months (mean, 11 months). One patient died of pulmonary metastasis at 8 months after operation and the other 5 survived without relapse or metastasis during follow-up. The intraoral paddles showed good shape with satisfactory speech function and swallowing recovery. The paddles also healed perfectly on the neck with flat outlooks, and all patients obtained full appearance and free movement of the neck. No fistula formed on the submandibular region and neck. Conclusion The bipaddled split pectoralis major myocutaneous flap can complete simultaneous immediate reconstruction of oral mucosal defect and neck defect. It is very useful in the treatment of recurrent oral cancer.

Citation： CHENJie, JIANGCanhua, LINing, GAOZhengyang, CHENLichun, WUXiaoshan, CHENXinqun, JIANXinchun. BIPADDLED SPLIT PECTORALIS MAJOR MYOCUTANEOUS FLAPS FOR IMMEDIATE RECONSTRUCTION OF ORAL MUCOSAL DEFECTS AND NECK DEFECTS AFTER RESECTION OF RECURRENT ORAL CANCER. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(7): 793-798. doi: 10.7507/1002-1892.20150172 Copy

1.	Xiao Y,Zhu J,Cai X,et al.Comparison between anterolateral thigh perforator free flaps and pectoralis major pedicled flap for reconstruction in oral cancer patients-a quality of life analysis.Med Oral Patol Oral Cir Bucal,2013,18(6):e856-e861.
2.	Zhang X,Li MJ,Fang QG,et al.A comparison between the pectoralis major myocutaneous flap and the free anterolateral thigh perforator flap for reconstruction in head and neck cancer patients:assessment of the quality of life.J Craniofac Surg,2014,25(3):868-871.
3.	Chao JW,Spector JA,Taylor EM,et al.Pectoralis major myocutaneous flap versus free fasciocutaneous flap for reconstruction of partial hypopharyngeal defects:what should we be doing? J Reconstr Microsurg,2015,31(3):198-204.
4.	Bussu F,Gallus R,Navach V,et al.Contemporary role of pectoralis major regional flaps in head and neck surgery.Acta Otorhinolaryngol Ital,2014,34(5):327-341.
5.	Patel K,Lyu DJ,Kademani D.Pectoralis major myocutaneous flap.Oral Maxillofac Surg Clin North Am,2014,26(3):421-436.
6.	Gadre KS,Gadre P,Sane VD,et al.Pectoralis major myocutaneous flap-still a workhorse for maxillofacial reconstruction in developing countries.J Oral Maxillofac Surg,2013,71(11):2005.e1-2005.e10.
7.	Jena A,Patnayak R,Sharan R,et al.Outcomes of pectoralis major myocutaneous flap in female patients for oral cavity defect reconstruction.J Oral Maxillofac Surg,2014,72(1):222-231.
8.	游云华,李芸,梁军,等.带血管蒂肌皮瓣修复放疗后口腔复发癌切除组织缺损的疗效分析.中华临床医师杂志(电子版),2012,6(19):5810-5813.
9.	毛驰,俞光岩,彭歆,等.改良的胸大肌皮瓣制备技术及其临床应用.现代口腔医学杂志,2003,17(3):227-229.
10.	Moloy PJ,Gonzales FE.Vascular anatomy of the pectoralis major myocutaneous flap.Arch Otolaryngol Head Neck Surg,1986,112(1):66-69.
11.	Reid CD,Taylor GI.The vascular territory of the acromiothoracic axis.Br J Plast Surg,1984,37(2):194-212.
12.	Palmer JH,Taylor GI.The vascular territories of the anterior chest wall.Br J Plast Surg,1986,39(3):287-299.
13.	Rikimaru H,Kiyokawa K,Inoue Y,et al.Three-dimensional anatomical vascular distribution in the pectoralis major myocutaneous flap.Plast Reconstr Surg,2005,115(5):1342-1354.
14.	Taylor GI,Chubb DP,Ashton MW.True and ‘choke’ anastomoses between perforator angiosomes:part i.anatomical location.Plast Reconstr Surg,2013,132(6):1447-1456.
15.	Taylor GI,Corlett RJ,Dhar SC,et al.The anatomical (angiosome) and clinical territories of cutaneous perforating arteries:development of the concept and designing safe flaps.Plast Reconstr Surg,2011,127(4):1447-1459.
16.	Taylor GI.The angiosomes of the body and their supply to perforator flaps.Clin Plast Surg,2003,30(3):331-342.
17.	Morain WD,Geurkink NA.Split pectoralis major myocutaneous flap.Ann Plast Surg,1980,5(5):358-361.
18.	Deo SV,Purkayastha J,Das DK,et al.Reconstruction of complex oral defects using bi-paddle pectoralis major flap-technical modifications and outcome in 54 cancer patients.Indian J Otolaryngol Head Neck Surg,2003,55(1):5-9.
19.	刘创明,卢永田,王晓彬,等.双岛胸大肌皮瓣在头颈肿瘤切除、重建术中的应用.山东大学耳鼻喉眼学报,2013,27(3):13-15.
20.	Bhola N,Jadhav A,Borle R,et al.Is there still a role for bilobed/bipaddled pectoralis major myocutaneous flap for single-stage immediate reconstruction of post ablative oncologic full-thickness defects of the cheek? Oral Maxillofac Surg,2015,19(2):125-131.

1. Xiao Y,Zhu J,Cai X,et al.Comparison between anterolateral thigh perforator free flaps and pectoralis major pedicled flap for reconstruction in oral cancer patients-a quality of life analysis.Med Oral Patol Oral Cir Bucal,2013,18(6):e856-e861.
2. Zhang X,Li MJ,Fang QG,et al.A comparison between the pectoralis major myocutaneous flap and the free anterolateral thigh perforator flap for reconstruction in head and neck cancer patients:assessment of the quality of life.J Craniofac Surg,2014,25(3):868-871.
3. Chao JW,Spector JA,Taylor EM,et al.Pectoralis major myocutaneous flap versus free fasciocutaneous flap for reconstruction of partial hypopharyngeal defects:what should we be doing? J Reconstr Microsurg,2015,31(3):198-204.
4. Bussu F,Gallus R,Navach V,et al.Contemporary role of pectoralis major regional flaps in head and neck surgery.Acta Otorhinolaryngol Ital,2014,34(5):327-341.
5. Patel K,Lyu DJ,Kademani D.Pectoralis major myocutaneous flap.Oral Maxillofac Surg Clin North Am,2014,26(3):421-436.
6. Gadre KS,Gadre P,Sane VD,et al.Pectoralis major myocutaneous flap-still a workhorse for maxillofacial reconstruction in developing countries.J Oral Maxillofac Surg,2013,71(11):2005.e1-2005.e10.
7. Jena A,Patnayak R,Sharan R,et al.Outcomes of pectoralis major myocutaneous flap in female patients for oral cavity defect reconstruction.J Oral Maxillofac Surg,2014,72(1):222-231.
8. 游云华,李芸,梁军,等.带血管蒂肌皮瓣修复放疗后口腔复发癌切除组织缺损的疗效分析.中华临床医师杂志(电子版),2012,6(19):5810-5813.
9. 毛驰,俞光岩,彭歆,等.改良的胸大肌皮瓣制备技术及其临床应用.现代口腔医学杂志,2003,17(3):227-229.
10. Moloy PJ,Gonzales FE.Vascular anatomy of the pectoralis major myocutaneous flap.Arch Otolaryngol Head Neck Surg,1986,112(1):66-69.
11. Reid CD,Taylor GI.The vascular territory of the acromiothoracic axis.Br J Plast Surg,1984,37(2):194-212.
12. Palmer JH,Taylor GI.The vascular territories of the anterior chest wall.Br J Plast Surg,1986,39(3):287-299.
13. Rikimaru H,Kiyokawa K,Inoue Y,et al.Three-dimensional anatomical vascular distribution in the pectoralis major myocutaneous flap.Plast Reconstr Surg,2005,115(5):1342-1354.
14. Taylor GI,Chubb DP,Ashton MW.True and ‘choke’ anastomoses between perforator angiosomes:part i.anatomical location.Plast Reconstr Surg,2013,132(6):1447-1456.
15. Taylor GI,Corlett RJ,Dhar SC,et al.The anatomical (angiosome) and clinical territories of cutaneous perforating arteries:development of the concept and designing safe flaps.Plast Reconstr Surg,2011,127(4):1447-1459.
16. Taylor GI.The angiosomes of the body and their supply to perforator flaps.Clin Plast Surg,2003,30(3):331-342.
17. Morain WD,Geurkink NA.Split pectoralis major myocutaneous flap.Ann Plast Surg,1980,5(5):358-361.
18. Deo SV,Purkayastha J,Das DK,et al.Reconstruction of complex oral defects using bi-paddle pectoralis major flap-technical modifications and outcome in 54 cancer patients.Indian J Otolaryngol Head Neck Surg,2003,55(1):5-9.
19. 刘创明,卢永田,王晓彬,等.双岛胸大肌皮瓣在头颈肿瘤切除、重建术中的应用.山东大学耳鼻喉眼学报,2013,27(3):13-15.
20. Bhola N,Jadhav A,Borle R,et al.Is there still a role for bilobed/bipaddled pectoralis major myocutaneous flap for single-stage immediate reconstruction of post ablative oncologic full-thickness defects of the cheek? Oral Maxillofac Surg,2015,19(2):125-131.

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BIPADDLED SPLIT PECTORALIS MAJOR MYOCUTANEOUS FLAPS FOR IMMEDIATE RECONSTRUCTION OF ORAL MUCOSAL DEFECTS AND NECK DEFECTS AFTER RESECTION OF RECURRENT ORAL CANCER

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