Objective To investigate the clinical effect ofthe pectoralis major myocutaneous flap and Ti-plate system in repairing mandibular defects caused by resection of oral carcinoma.Methods From November 2001 to February 2003, 32patients with mandibular defect caused by resection of oral carcinoma were treated. Combined radical neck dissection with resection of gingival and mandible was performed on 11 patients with carcinoma of the lower gingival, combined radical neck dissection with glossectomy and mandibulectory on 13 patients with carcinoma of tongue, combined radical neck dissection with resection of floor of mouthand mandible on 4 patients with carcinoma of floor of mouth, and combined radical neck dissection with resection of cheek and mandible on 4 patients with carcinoma of buccal mucosa, respectively. The defects of mandible were associated with soft-tissue component, the sizes of defect ranged from 5.5 cm×7.6 cm to 8.2 cm×10.5 cm. The defects were reconstructed with 6 cm×7 cm to 9 cm×10 cm pectoralis major myocutaneous flaps and Tiplate system. The effect was studied retrospectively. Results Thirty-two cases were followed for 219 months; 29 cases offlaps survived and 3 cases of flaps partly necrosed (10% or less of the skin paddle). The appearance of face was satisfactory in 27 patients, and slight deformity of face was observed in 5 patients. The occluding relation and masticatory function were recovered well. Opening mouth extents ranged from 2.7 cm to 3.4 cm. No temporomandibular arthrosis relating to operation was found in all cases. Conclusion A combination of thhe pectoralis major myocut aneous flap and Ti-plate system is an ideal method for reconstruction of mandible defects associated with soft-tissue component after radical operation of oral carcinoma.
Objective To explore the outcome of hypopharynx reconstruction by using remaining laryngeal mucosa flap and pectoralis major myocutaneous flap in advanced pyriform sinus cancer.Methods Twelve patients with pyriform sinus cancers underwent hemilaryngectomy and partial pharyngectomy, two patients underwentcervical esophagectomy at the same time. The defects were reconstructed by remaining laryngeal mucosa flap. Four cases were involved in the bilateral larynx, received total laryngectomy and were repaired by pectoralis major myocutaneous flap. Results There was no operative fatal case and all flaps survived. Only one suffered from postoperative pharyngocutaneous fistulas, whose defect was reconstructed by remaining laryngeal mucosa flap and had radiotherapy. All patients could swallow ordinary food and had no benign esophagostenosis and pharyngostenosis after operation. Out of 16 pateints, 1 case died of general metastasis;3 cases died of local tumor relapse, tumor relapse of cervical lymphonode and lung metastasis respectively within 1 year after operation; the other 12 casessurvived over 2 years.Conclusion The advantage of hypopharynx reconstruction with remaining laryngeal mucosa flap is simple and convenient with less trauma and complication. The reconstruction should be completed by using the pectoralis major myocutaneous flap when the bilateral larynx are involved in.
Twohundrednineteen orofaciomaxillary tumours, 18 benigns and 201 malignancies, were repaired by pectoralis major myocutaneous flaps following their resections. The types of flaps used in the repair were: single island myocutaneous flaps in 201 cases, doubleisland myocutaneous flaps in 16 cases, and myocutan eous skeletal flaps in 2 cases. The results were susscessful in 201 cases and failure in 18. The advantages and indications of using pectoralis major myocutaneous flaps were discussed. The method of design and its relevent surgical thechniques were introduced, and the factors responsible for the success and failure were analyzed. It is noted that the correct and meticulous operative techniques were the main factors leading to operative success.
The pectoralis major myocutaneous flap was used to repair laryngopharyngeal and esophageal defect following radical excision of pharyngeal and inferior laryngeal carcinomas in 3 cases. The results were susscessful. The patients were follwedup for 6 months to 3 years. The deglutition functions were all reestablished, the general nutritional conditions were improved, and no recurrence or distant metastasis was observed. The advantages of this operative procedure were discussed.