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

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Continuous Validity of Pedicled Myocutaneous & Myofascial Flaps
Table (3): Postoperative complications in different groups according to type of reconstruction.
Complication
No.
Group I
%
No.
Group II
%
No.
Group III
%
Infection:
Mild
Severe
15
1
17.8
1.2
1
–
7
–
2
–
16.6
–
Sloughing:
Partial
Major
3
1
3.6
1.2
1
–
7
–
1
–
8.3
–
Flap dehiscence & retraction:
Minor
Severe
4
1
4.8
1.2
2
–
14
–
1
–
8.3
–
Fistula:
Minor
Major
11
1
13
1.2
–
–
–
–
2
–
16.6
–
Wound dehiscence at donor site
Seroma at donor site
Hematoma at donor site
Pharyngeal stenosis
–
–
-
1
–
–
–
1.2
2
–
1
–
14
–
7
–
1
2
–
–
8.3
16.6
–
–
The (LTMC) flap was used in 14 patients.
The most common pathology was squamous
cell carcinoma diagnosed in 6 patients. Other
types of pathology included parotid carcinoma
(2 cases), recurrent basal cell carcinoma (2
cases), basosquamous cell carcinoma (one case),
sebaceous adenocarcinoma (one case), fibrosarcoma
(one case) and malignant peripheral
nerve sheath tumor (one case). The occiput was
the most common site for reconstruction (9
cases). Other sites included the parotid region
(2 cases), the ear pinna (one case), the external
auditory meatus (one case) and the posterior
neck (one case). All wounds were closed primarily
and preservation of the superior fibres
of the trapezius enabled almost normal abduction
of the arm. Only (1 case) developed partial
distal sloughing of the skin island for which
debridment was done. Minor dehiscence occurred
in 4 cases (the recipient area in 2 cases
and the donor site in 2 cases. All cases were
properly managed conservatively by repeated
dressings. Figs. (10-14) show different operative
views.
The latissimus dorsi myocutaneous flap was
used in 12 cases. It was used for reconstruction
of oral defects in 8 patients of whom 6 cases
were females with large breasts, one case presented
with local recurrence on top of previously
used (PMMC) flap for reconstruction Figs.
(15A-C) and one case was properly salvaged
after failure of previous reconstruction by (PM-
MC) flap. Other indications included major
defects after excision of advanced parotid carcinoma
(one case), advanced epithelioma of the
ear pinna (one case), synovial sarcoma of the
neck (one case) Figs. (16A-C) and anterior
pharyngeal defect after salvage laryngectomy
in a case of laryngeal carcinoma that had failure
of treatment by radiotherapy. Only one case
developed minor sloughing of distal skin island.
Other complications with this flap was seroma
at the donor site (2 cases), minor fistulae (2
cases), minor dehiscence at the recipient site
(one case) and at the donor site (one case). All
were properly treated conservatively with aspiration
in seroma cases and repeated dressings
in the latter.
The temporalis myofascial flap was used in
(12 cases). In 6 cases it was used to reconstruct
the orbital floor after total maxillectomy for
maxillary carcinoma. In 2 cases it was used to
reconstruct the lateral and floor of the orbit
after excision of epithelioma of the cheek invading
the zygomatic arch. It was used for
reconstruction after orbital exenteration in 4
cases. In one case it was used to fill the orbital
cavity and internal eye prosthesis was put, in
another case it was used to cover the dura in a
defect in the orbital roof and in the other 2 cases
it was used to cover the orbital cavity anteriorly
with overlying skin graft and external eye prosthesis.
There was no flap related postoperative
complications.