Research open access the submental flap for oral cavity. The conventional technique of harvesting a pmmc flap involves a single vascular supply from the pectoral branch of the thoracoacromial artery. Both flaps having distinct advantage of relative ease in elevating flap and robust vascularity with acceptable aesthetic and functional outcome. The fibula free flap and pectoralis major flap combination mohammed qaisi,1,2,3 ryan dee,2 issam eid,4 james murphy,2,5 ignacio a. It is known for its use in chest wall and postmastectomy reconstruction and has also been used effectively for coverage of large soft tissue defects in the head and neck, either as a pedicled flap or as a microvascular. The extent of coverage and the reach of the flap are dependent on the anatomy of the patient, modifications of the standard techniques of. Uses the pectoralis major island flap can be used in reconstructions 1. In this study, parachute technique was adopted for free flap inset in patients without mandibulotomy.
Clinical study vascular waveform analysis of flapfeeding. He is actually editorinchief of plastic and aesthetic research, assistant. The objective of this study was to assess the versatility of pectoralis major myocutaneous pmmc flap in the reconstruction of diverse surgical defects following resection of various head and neck malignancies. Seldom studies reported the case in which the skin area of previous modified radical mastectomy mrm had been used as a pmmc flap in head and neck reconstruction. Application of parachute technique for free flap reconstru. Pedicled flaps in head and neck surgery slideshare. Thyromental distance was 6 cm, atlantoaxial mobility was adequate.
Jan 08, 2016 pedicled flaps in head and neck surgery 1. Crossed pectoralis major myocutaneous flap for recurrent oral. Pectoralis major myocutaneous flap in head and neck reconstruction by dr. Since it was described, the flap has been extensively used for reconstruction of small to moderate size oral cavity soft tissue defects 9. Pectoralis major myocutaneous flap in head and neck reconstruction 1. Disponiamo di unampio catalogo di prodotti delle migliori marche sul mercato.
Tongue flap takes advantage of these properties of tongue but within narrow limits. The construction and working of a pmmc instrument article716. Pectoralis major myocutaneous flap reconstruction for the. Carotid artery blow out is a dreaded complication in the postoperative setting of head and neck oncological surgeries. Contemporary role of pectoralis major regional flaps in. Jun 17, 2019 the latissimus dorsi myocutaneous flap ldmf is one of the most reliable and versatile flaps used in reconstructive surgery. Myocutaneous flaps commonest reconstructive option for head and neck defects include.
The aim was to evaluate the feasibility of pectoralis major myocutaneous pmmc flap in reconstruction of defects in the head and neck region. Versatility of pectoralis major myocutaneous flap in. Pmmc flap can be a reliable option for advanced oral malignancies. In this a study we assessed the usefulness of the supraclavicular artery flap in head and neck oncologic. It is an emergency situation which requires immediate highly guarded decisions to explore and ligate are made in short spell of time keeping. After stephan ariyan first described its use for head and neck reconstruction in 1979, it has become tremendously popular and has revolutionised head and neck cancer surgery. Doublepaddled pectoralis major myocutaneous flap as an alternative to microvascularized free flaps in complex orocervical defects plastic and aesthetic research is an open acccess journal, which publishes articles on technical and clinical studies related to plastic and aesthetic surgery.
Ariyan 1979 work house flap for head and neck reconstruction regional pedicle flap 2. Crossed pectoralis major myocutaneous flap for recurrent oral cavity. The submental flap is gaining popularity as a simple technique for reconstruction of. A novel technique of raising a pectoralis major myocutaneous. The flap was raised using standard surgical technique leaving its. The earliest reported use of this flap for reconstruction in oral carcinoma was by sterne and hall 8 in 1996.
Pmmc flap is a versatile flap for reconstruction of soft tissue defect in head and neck cancer for primary aswell as salvage reconstruction. The pectoralis major flap johan fagan the pectoralis major flap comprises the pectoralis major muscle, with or without overlying skin, and may include the underlying ribs. One advantage of this technique is the ease of harvest of the widely accepted pmmc flap even for the novice surgeon. Pectoralis major myocutaneous flap and myofascial flap iowa. Extensive throughandthrough oromandibular defects after advanced oral carcinoma excision pose a reconstructive challenge for the head and neck surgeon. In the first group of patients 314 patients required reoperation for fistula recurrence, whereas in the second group this complication never occurred. Extended pectoralis major myocutaneous flap in head and neck. Pectoralis major myocutaneous pmmc flap, based on the thoracoacromial artery, whose first description is commonly attributed to ariyan in 1979 who exhaustively described the technique and its anatomical basis 1, was however reported in 1977 by at least two authors 2 3.
The latissimus dorsi myocutaneous flap ldmf is one of the most reliable and versatile flaps used in reconstructive surgery. As a result, these defects are often not amenable to reconstruction with a single flap due to the volume of. Permanent magnet moving coil instruments pmmc the permanent magnet moving coil instruments are most accurate type for direct current measurements. Workshop on tips and tricks of neck dissection and reconstruction of oral cavity defects will help the post graduate students and other young surgeons working. Journal of dentistry and oral biology impact factor. The submental artery flap was first described by martin et al 7 in 1993. Average flap survival with free tissue transfer has been reported to be 96. The standard surgical technique was used to harvest pmmc flap, those in whom extra length of the flap pedicle was required the muscle was dissected in hockey. A pedicle pectoralis major musculocutaneous pmmc flap is one of the strategies for head and neck reconstruction. Pectoralis major flap vula university of cape town. The pectoralis major myocutaneous flap pmmc flap represents a landmark in the development of head and neck reconstructive surgery. The pmmc flap is reliable with less than 10% of the major complication rate requiring reoperation. The study also outlines types of other tissue required, the donor site morbidity and the technical details of the operative procedure.
It has an axial blood supply and is based superiorly on the pectoral branch of the thoracoacromial artery. The operative technique used was essentially the same as that. We used pmmc flap in about 125 patients last year for head and neck reconstruction. Proximal pedicle transection in our current practice, transection of the base of the deltopectoral flap is rarely needed for its most common uses ie, skin or carotid coverage. Use of pectoralis major myocutaneous flap for resurfacing. Pmmc flap was raised in standard fashion with skin paddle of 7 cm x 8 cm to fill the mucosal defect.
These complex oromandibular wounds often involve the mandible, oral andor aerodigestive mucosa, and the external skin. In india head and neck cancer patients usually present in the advanced stage making pmmc flap a viable option for reconstruction. We propose a novel surgical reconstructive technique of use of combine pectoralis major myocutaneous flap pmmc with nasolabial flap for full thickness cheek defect involving large lip commisure. Velasco martinez,6 and henry fung2 1oralhead and neck oncologymicrovascular surgery, cook county hospital, usa 2division of oral and maxillofacial surgery, cook county hospital, usa. Clinical study vascular waveform analysis of flapfeeding vessels using color doppler ultrasonography akihirooginoandkiyoshionishi department of plastic and reconstructive surgery, omorinishi, ota.
Then, a short time reconstructive surgery with a pmmc flap was started. A prospective database of patients who were reconstructed with dorsal tongue flap between july 2006 and november 2010 was used. Reconstruction for complex oromandibular facial defects. The pectoralis major myocutaneous flap in head and neck. Using a pedicle pectoralis major musculocutaneous flap in he. An immediate reconstructive surgery with a pectoralis major. Tongue flap revisited deshmukh a, kannan s, thakkar p. It has been considered for decades the workhorse for head and neck reconstruction, and is still. Pmmc flap provides adequate bulk and soft tissue to permit healing in this area and rich vascularity to permit a full course of postoperative radiation therapy. Due to its ready availability, ease of harvest and reliability, it soon became the choice of reconstruction for postablative defects in the head and neck region. Seldom studies reported the case in which the skin area of previous modified radical mastectomy mrm had been used as a pmmc flap in head and neck reconstruction patient concerns. Bipaddle pmmc is cumbersome in patient with fatty chests or females. In this a study we assessed the usefulness of the supraclavicular artery flap in head and neck oncologic defects. After stephan ariyan first described its use for head and neck reconstruction in 1979, it has become tremendously popular.
Overall flap related complications were recorded in 40. The need of the hour is a versatile flap which has the advantages of both a regional flap viz. A modified pectoralis major myocutaneous flap technique with. Improved skin paddle survival in pectoralis major myocutaneous. Since pectoralis major myocutaneous pmmc flap is the most widely used first flap for reconstruction, it is exhausted at the earliest and recurrence poses a formidable challenge for reconstructive surgeon. The pectoralis major myocutaneous pmmc flap has been used as a versatile and reliable flap since its first description by ariyan in 1979. Contemporary role of pectoralis major regional flaps in head. Case 1 lesion in left retromolar trigone, posted for a left commando with pectoralis major myocutaneous flap pmmc flap. Truview pcdvideo laryngoscope aided nasotracheal intubation. Supraclavicular artery flap for head and neck oncologic. Use of pectoralis major myocutaneous flap for resurfacing the soft tissue defects of head and neck rampukar chaudhary, md sohaib akhtar, lalit mohan bariar, mohammed fahud khurram post graduate department of burns, plastic and reconstructive surgery, jnmc, amu, aligarh, uttar pradesh, india. Clinical study vascular waveform analysis of flap feeding vessels using color doppler ultrasonography akihirooginoandkiyoshionishi department of plastic and reconstructive surgery, omorinishi, otaku, tokyo, japan. Pectoralis major myocutaneous flap in head and neck. Abstract pdf fulltext epub the head and neck cancer are sixth most common cancers worldwide with cancer of oral cavity.
Composite resection, guide flange prosthesis, maxillary obturator, squamous cell carcinoma. A flap is a unit of tissue that is transferred from one site donor site to another recipient site while maintaining its own blood supply. Doublepaddled pectoralis major myocutaneous flap as an. They range from simple advancements of skin to composites of many. Pdf crossed pectoralis major myocutaneous flap for recurrent oral. Full text optimal management of postlaryngectomy pharyngo. Pmmc with single stage deltopectoral dp composite flap in. This article describes the early prosthodontic management of a patient who had underwent a composite resection with left modified radical neck dissection mrndii reconstructed with an autogenous pectoralis major myocutaneous pmmc flap. The anatomy of the pmmc flap is well described in the. An immediate reconstructive surgery with a pectoralis. To assess the usefulness of singlestaged posteriorly based dorsal tongue flap in oral cavity reconstruction following ablative surgery, in terms of flap viability, functional outcome and donor site morbidity. Pectoralis major myocutaneousflap in head and neck cancer. Since pectoralis major myocutaneous pmmc flap is the most. Hamahata et al 37 compared the surgical results obtained with the conventional double layer suture operation using pmmc flap and the triplelayer suture operation with frilled pmmc flap.
The action of these instruments is based on the motoring principle. Pmmc with single stage deltopectoral dp composite flap. Pectoralis major myocutaneous pmmc flap continues to be the workhorse in head and neck reconstruction. Head and neck oncologic resections often leave complex defects which are challenging to reconstruct. The pectoralis major flap was first described in 1968 and later popularized for head and neck reconstruction by ariyan in 1979. When a current carrying coil is placed in the magnetic field produced by permanent magnet, the coil experiences a force and moves. Poor flap appearance may potentially be improved with the use of iv dextran, steroids, andor hyperbaric oxygen.
Use of pectoralis major myocutaneous flap for resurfacing the. Although free tissue transfer has revolutionized the reconstruction in cancers of the oral region, pmmc is still considered a readily accessible source of vascularized soft tissue available to the reconstructive surgeon and especially in most developing nations where due to the cost, time. Forehead flap was delayed after 6 weeks of surgery and final detachment and insetting was done in 7th week. Pmmc and lateral forehead flap was used for reconstruction. Saudi journal of medical and pharmaceutical sciences. Successful reconstruction of large oropharyngeal defect with. It is an emergency situation which requires immediate highly guarded decisions to explore and ligate are made in short spell of time keeping the fact of high mortality rate and neurological complications. Research open access the submental flap for oral cavity reconstruction. Crossed pectoralis major myocutaneous flap for recurrent. A novel technique of raising a pectoralis major myocutaneous flap through the skin paddle incision alone article in journal of surgical oncology 862. The working principal of this instrument is same as that of the darsonval type of galvanometers,the difference. Pdf background oral cavity cancers are fairly common and have propensity to recur locally. We have modified the technique of flap in such a way that edge of flap is sutured to neck dissection wound. On airway assessment iid was 15 mm with mallampati class iv a.
The flap elevation was started by using valleylab with v mode for skin incision without a scalpel from the right clavicle part to proximal direction without blood loss. Jan 29, 2007 pectoralis major myocutaneous pmmc flap continues to be the workhorse in head and neck reconstruction. Pmmcthe permanent magnet moving coil instrument is the most accurate type for d. Plastic and aesthetic research is an open acccess journal, which publishes articles on technical and clinical studies related to plastic and aesthetic surgery. Using a pedicle pectoralis major musculocutaneous flap in. Case report reconstruction for complex oromandibular facial defects. Lateral forehead based on right sta was raised for skin cover. Extended indications and technical refinements ayman a amin1, mostafa a sakkary1, ashraf a khalil2, mohammmed a rifaat1 and sherif b zayed1 abstract background and purpose. The basic treatment modality for the carcinoma of oral cavity has been surgery and the large defects resulting from the ablation of the tumors require reconstruction. Successful reconstruction of large oropharyngeal defect. At a minimum, special attention needs to be paid to vessel geometry and avoiding compression from the overlying pmmc flap. The average size of the pmmc paddle used for the external defects was 7 3.
To cover the carotid artery when this vessel is at risk due to prior irradiation 6. Sep 15, 2019 abstract pdf fulltext epub the head and neck cancer are sixth most common cancers worldwide with cancer of oral cavity. The indications and complications of pectoralis major. In 24 cases, bipedal pmmc flap with tram track deepithelization was used to cover mucosal and skin defect simultaneously. Mar 02, 2015 pectoralis major myocutaneous flap in head and neck reconstruction 1. Abstract pdf fulltext epub the aim of this study is to evaluate crude extract, ethyl acetate, chloroform and butanol fractions of p. The principle of tongue flap is equitable redistribution of mucosa from relative abundance on the tongue to an adjoining excisional defect without significantly hampering the functions of the tongue. An 84yearold female who had suffered from left breast cancer and undergone a left. The working principal of this instrument is same as that of the darsonval type of galvanometers,the difference being that a direct reading instrument is provide with a pointer and a scale. Oral cavity cancers are fairly common and have propensity to recur locally. Pmmc flap is the main tool for reconstruction in our department due to easy availability and reliability.
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