Continuous Validity of Pedicled Myocutaneous and Myofascial ... - NCI

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Continuous Validity of Pedicled Myocutaneous & Myofascial Flaps
reconstruction after resection of malignant tumors
of different sites in the head and neck.
The study included 121 patients with head and
neck cancer operated upon at the National Cancer
Institute, Cairo University and Alminia
Cancer Center over 3 years duration, between
July 2005 and the end of July 2008.
One hundred and 2 cases receieved no previous
treatment while 19 cases presented with
recurrent or persistent disease after previous
treatment by surgery alone in 3 cases, combined
surgery and radiotherapy in 4 cases and radiotherapy
alone in 12 cases.
Preoperative medical assessment included
routine complete blood picture, liver and kidney
functions, fasting blood sugar, bleeding and
coagulation profile and cardiological assessment.
All the patients were biopsied before
surgery and pathological diagnosis was obtained.
The stage of the disease was evaluated by
clinical assessment, locoregional (CT or MRI),
routine CXR and other metastatic workup as
indicated.
The extent of surgical resection and the
technique of reconstruction with its potential
complications were discussed preoperatively
with the patient with combined signed consent
by the patient and the surgeon performing the
operation.
Four types of pedicled flaps were used for
reconstruction namely the Pectoralis major
myocutaneous (PMMC) flap (Group I), lower
trapezius myocutaneous flap (LTMC) flap
(Group II), Latissimus dorsi myocutaneous flap
(Group III) and the Temporalis myofascial flap
(Group IV). Immediate reconstruction after
resection was done in 110 cases while delayed
reconstruction of anterior pharyngeal defects
after total laryngectomy was done in 11 cases.
In one case in (Group I), major flap loss developed
and was successfully salvaged by pedicled
latissimus dorsi myocutaneous flap.
Patients were followed-up in the outpatient
clinic for detection of local or distant recurrences
by clinical examination and radiological assessment
as indicated and for assessment of the
final functional and aesthetic results.
Data regarding the type of tumor, site of
tumor, stage of the disease, the type of myocutaneous
flap used, postoperative complications
and the total hospital stay were collected and
analyzed. Utility of the different types of these
flaps was reevaluated in terms of advantages,
indications, and morbidity.
RESULTS
This study included 3 types of repair in head
and neck region using 4 different types of pedicled
myocutaneous or myofascial flaps ( repair
of mucosal defects, repair of composite mucosal
& skin defects and repair of skin only defects).
Most of the cases were associated with bulky
soft tissue and bone defects. In cases with combined
mucosal & skin defects (29 cases) the
myocuteous flaps mainly the (PMMC) flap
(used in 28 cases) were used for one of the
following purposes:
1- Replacing the inner mucosal layer and using
the deltopectoral fasciocutaneous flap for
skin closure (17 cases).
2- Replacing the outer skin layer, while the
inner mucosal defect was not reconstructed
(2 cases) after maxillectomy.
3- Replacing both the inner mucosal and outer
skin layers using long skin territory which
was folded on itself (bipaddle skin flap) in
9 cases.
Primary sites of malignancy and types of
defects left after excision are represented in
Table (1). Oral carcinoma represented most of
the cases (71 cases) and the majority were at
advanced stage (T3 & T4) representing 40.8%
(29/71) and 33.8% (24/71) respectively.
Different types of flaps used in our study
are represented in Table (2). The overall postoperative
complications was 19.8% (24/121).
It was 20% (17/84) in group I, 28.6% (4/14) in
group II, and 25% (3/12) in group III. No flap
related complications were reported in group
IV. The mean hospital stay was 14 days (range,
8-27 days) in group I, 11 days (range, 8-15
days) in group II, 12 days (range, 8-16 days)
in group III, and 8 days (range, 5-11 days) in
group IV.
The (PMMC) flap was the most commonly
used flap (84 cases ). Figs. (1-9) show different
operative views. The postoperative common
complications in group I were mild infection