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

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252 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.
Maged M. Elshafiey, et al. 253 Fig. (1-A): Sq.C.C. of the alveolar margin. Fig. (1-B): Skin paddle of the (PMMC) flap was sutured to the tongue. Fig. (2-A): Bipaddle (PMMC) flap, the upper one was used for mucosal replacement and the lower one was used for skin replacement. Fig. (2-B): Composite oral defect with mucosal and skin defects replaced with bipaddle (PMMC) flap. Fig. (3-A): Late postoperative view of bipaddle (PMMC) flap seen from outside. Fig. (3-B): Late postoperative view of bipaddle (PMMC) flap seen from inside.
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Continuous Validity of Pedicled Myocutaneous and Myofascial ... - NCI

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