Role of pectoralis major flap in resource limited settings (developing world): A case report of huge neck cancer done in Tanzania

Skin cancers are common in head and neck region particularly Basal cell carcinoma and Squamous cell carcinoma. Treatment options includes wide local excision with neck dissection followed by adjuvant radiation/chemo/chemoradiation. We report a case of a huge skin cancer of the neck about 8.5 cm in its greatest dimensions and reconstructive techniques of the defect using pectoralis major flap in a 61-years old Albino patient, what’s important is good understanding of anatomy and surgical land marks to identify the thoracoacromial artery which is the main feeder to the flap. Reconstruction was successful with acceptable morbidity and the patient was sent for chemoradiation with no reported recurrence. Presentation from this case demonstrates that the pectoralis major flap still remains the ‘workhorse’ of reconstruction in Tanzania. It is advocated to be used in resource limited countries, effectively with acceptable morbidity and results.

Clavicle Survival as a Free Bone Graft: A Case Report of Minor Modification Added to Pectoralis Major Flap

Introduction: Reconstruction of the surgically created defects in the head and neck regions is a crucial step in the patients’ treatment plan. Regarding the involved tissues, various flaps and grafts have been introduced in the literature. The pectoralis major myocutaneous flap (PMMF) is one of the most versatile flaps with many variations for providing more advantages. Also, when bone tissue is needed, it can be reconstructed via an osteomyocutaneous flap including rib, sternum, or clavicle. Case Presentation: In this article, a case of oral squamous cell carcinoma with the extension to facial structures and, then, reconstructed with PMMF was presented, in which a medial half of clavicle bone was resected and employed as a free bone graft. Conclusions: Sectioning clavicle not only increases the arc of rotation and mobility of the PMMF but also provides a new source of bone graft in the vicinity. Besides, the survival of the graft and integration with the native bone is noteworthy.

Pectoralis Major Onlay vs Interpositional Reconstruction Fistulation After Salvage Total Laryngectomy: Systematic Review and Meta-analysis

Objective To evaluate the difference in pharygocutaneous fistula (PCF) development between pectoralis major flap onlay and interpositional reconstructions after salvage total laryngectomy (STL). Data Sources Medline, Cochrane, Embase, Web of Science, CINAHL, and ClinicalTrials.gov. Review Methods A systematic review was performed during January 2020. English articles were included that described minor and major PCF rates after STL reconstructed with pectoralis major onlay or interposition. PCFs were classified as major when conservative therapy was unsuccessful and/or revision surgery was needed. Articles describing total laryngopharyngectomies were excluded. Meta-analyses of the resulting data were performed. Results Twenty-four articles met final criteria amassing 1304 patients. Three articles compared onlay with interposition, and 18 compared onlay with primary closure. Pectoralis interposition demonstrated elevated odds ratio (OR) of PCF formation as compared with onlay (OR, 2.34; P < .001). Onlay reconstruction reduced overall (OR, 0.32; P < .001) and major (OR, 0.21; P < .001) PCF development as compared with primary pharyngeal closure alone. Data were insufficient to compare interposition against primary closure. Conclusions This research shows evidence that pectoralis onlay after STL diminishes the odds of total and major PCF development. Pectoralis interposition reconstruction showed elevated odds of PCF formation as compared with pectoralis onlay.

VARIATIONS AND MODIFICATIONS OF FAR-FAMED PECTORALIS MAJOR FLAP: A REVIEW OF LITERATURE

The pectoralis major flap is undoubtedly a workhorse flap in the field of head and neck oncology even with the advent of free flaps. Lack of expertise and resources limits the use of free flap and still makes pectoralis major flap widely chosen. Head and neck cancer in advanced stage requires extensive resection entailing reconstruction of various sized defects which is possible only with a versatile flap. This flap is also a salvage flap when all the other options failed, since four decades. The purpose of this article is to highlight variations and modifications related to pectoralis major flap in head and neck reconstructive procedures. For this a thorough literature search was done using Medline and PubMed databases. Non-English language papers were excluded from the review. A total of 50 articles were obtained through verification of the title and abstract. Considering the relevance of the matter 32 articles were opted for the present review.