Doublepaddled pectoralis major myocutaneous flap as an. The pectoralis major musculocutaneous pmmc flap has been a workhorse flap, even in a freeflap era since its first report in 1979 by ariyan. Versatility of pectoralis major myocutaneous flap in. This is distinct from a graft, which does not have an intact blood supply and therefore relies on growth of new blood vessels. Modified pectoralis major myocutaneous flap for the total glossectomy defects. Pectoralis major myocutaneous pmmc flap continues to be the workhorse in head and neck reconstruction. We were forced to perform flap reconstruction on a patient who suffered necrosis due to impeded blood flow of the transplanted intestinal tract after twice conducting. Head and neck oncologic resections often leave complex defects which are challenging to reconstruct.
The development of reconstructive techniques further revolutionized the success. To cover the carotid artery when this vessel is at risk due to prior irradiation 6. Lateral forehead based on right sta was raised for skin cover. This is done to fill a defect such as a wound resulting from injury or surgery when the. Bipaddle pectoralis major myocutaneous flap for single. Modified pectoralis major myocutaneous flap for the total. 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. Request pdf pmmc flap revisited and its clinical outcome in 150 patients introduction pectoralis myocutaneous flap remains the workhorse for the reconstruction of large defects in the head and. Although we use free flaps as the first choice for head and neck.
The omentum is a wellestablished pedicled flap for coverage of intraabdominal and thoracic pathology, and as a freeflap for a multitude of applications. The pectoralis major myofascial pmmf flap, a simple variant of the. Successful reconstruction of large oropharyngeal defect. Using a pedicle pectoralis major musculocutaneous flap in. In the present case, we have presented a case of malignant melanoma of gingivobuccal complex, involving the hard palate where the palatal defect was successfully reconstructed by the pmmc flap.
Pmmc and lateral forehead flap was used for reconstruction. Bipaddle pmmc is cumbersome in patient with fatty chests or females. The pectoralis major myocutaneous pmmc flap has been used. Detailed threedimensional vascular networking of the pmmc flap had been. Pedicled flaps remain a safe option in the context of high surgical risk patients, presence of fistula. In 1979, ariyan was the first to describe the use of the pmmc flap in head and neck reconstruction. Pmmc flap can be successfully used in patients with advanced malignancies to repair the palatal defect without any significant postoperative complication. Breast cancer in the lower jaw after reconstructive surgery with a pectoralis major myocutaneous flap pmmc a case report, european journal of medical research, 2011, pp. The study also outlines types of other tissue required, the donor site morbidity and the technical details of the operative procedure. Download more than 33,000 ebooks for every ereader or reading app out there.
Case report mucormycosis at pectoralis major myocutaneous flap. The vascular anatomy of the pectoralis major myocutaneous flap. Surgery at mahatma gandhi cancer hospital, miraj maharashtra. Breast cancer in the lower jaw after reconstructive.
Pdf the role of the pectoralis major myocutaneous flap pmmf in head and neck reconstruction is. Pectoralis major myocutaneous flap in head and neck reconstruction by dr. An 84yearold female who had suffered from left breast cancer and undergone a left. Visit to know long meaning of pmmc acronym and abbreviations.
Reconstruction of full thickness defects after resection of oral cancer is a challenge. Since 1940, with the advent of newer techniques of radical surgery and incontinuity neck dissection, patient survival and functional rehabilitation have significantly improved. Pectoralis myocutaneous flap remains the workhorse for the reconstruction of large defects in the head and neck region despite free flaps gaining popularity. Reconstruction of esophageal stenosis that had persisted for 40. An immediate reconstructive surgery with a pectoralis. Study on the vascular pattern of the pectoralis major. 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.
When a current carrying coil is placed in the magnetic field produced by permanent magnet, the coil experiences a force and moves. The pectoralis major myocutaneous pmmc flap can be used as either a pedicled or a free flap. Chittaranjan otolaryngologists society,world journal of. Established uses include esophageal luminal augmentation, reconstruction of oral cavity and oropharyngeal defects, lateral. Pmmc flap reconstruction showing bulky enhancing recurrent mass arrows at the upper end of the flap. Radical neck dissection and pmmc flap reconstruction for oral cancer this. Reconstruction of esophageal stenosis that had persisted for 40 years.
It is one of the best place for finding expanded names. The boomerangshaped pectoralis major musculocutaneous. In this a study we assessed the usefulness of the supraclavicular artery flap in head and neck oncologic. 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. Contemporary role of pectoralis major regional flaps in. The pmmc flap is still considered a workhorse flap for soft tissue reconstruction of the head, face, and neck hfn region, particularly in developing and underdeveloped countries. Although commonly used in adults, it has been hardly described for reconstruction in children. They are very sensitive and maintain a high degree of accuracy over long periods. For head and neck as well as for oromaxillofacial surgery, the use of the pectoralis major myocutaneous pmmc flap is a standard reconstructive technique after radical surgery for cancers in this region. Fasciocutaneous free flap and jejunal free flap are effective for circumferential defect. The pectoralis major musculocutaneous flap pmmcflap has been used for the immediate reconstruction of defects in thc head and neck region. The limited availability of reconstruction materials can often make it difficult to treat defects in the esophagus caused by necrosis of the transplanted intestinal tissue after cervicothoracic esophagus reconstruction. Operative technique for the preparation of pectoralis. Of the 12 pmmc flap surgeries performed, 3 were carried out as primary reconstructive procedures, whereas 9 were done as salvage procedures.
Fasciocutaneous flap reconstruction of the tongue and. Although microvascular free flaps are considered the first choice, their use is limited in the developing regions by availability of resources and the expertise. The pectoralis major musculocutaneous pmmc flap has been a useful technique for head and neck reconstruction since its first description by ariyan in 1979. Whereas forehead flap are esthetically not suitable for large defects. The denervated muscle loses bulk with time which might be advantageous or disadvantageous, depending on the functional and cosmetic objecttives of the flap. The pectoralis major myocutaneous pmmc flap or its modification was used in 19 cases after resectional surgery for malignancy of the oral cavity with minimal morbidity and no mortality. Pmmc flap was raised in standard fashion with skin paddle of 7 cm x 8 cm to fill the mucosal defect.
Flap design pectoralis major the flap may be employed either as a muscular or musculocutaneous flap, with or without the 4th thor 5 ribs. Extended pectoralis major myocutaneous flap in head and. Pectoralis major myocutaneous flap for the reconstruction. The pectoralis major myocutaneous pmmc flap has been considered the workhorse reconstructive flap for head and neck defects since its initial description in the late 1970s. A pedicle pectoralis major musculocutaneous pmmc flap is one of the strategies for head and neck reconstruction. Pectoralis major myocutaneous flapstill a workhorse for. Cannona technique for subtotal excision of the trachea and establishment of a sternal tracheostomy.
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. Supraclavicular artery flap for head and neck oncologic. Uses the pectoralis major island flap can be used in reconstructions 1. We have modified the technique of flap in such a way that edge of flap is sutured to neck dissection wound. Objectives to quantify functional and other outcomes after major resection and fasciocutaneous freeflap reconstruction of the tongue and floor of mouth, and to describe reconstructive technique design a hypothesisgenerating, retrospective cohort study of 43 patients who underwent, at minimum, a hemiglossectomy and resection of the floor of the mouth for oral cancer followed by. Pectoralis major myocutaneous flap pocket dentistry. It has been considered for decades the workhorse for head and neck reconstruction, and is still. Full text pdf 180k abstracts references4 the surgical procedure of lifting of a pmmc flap and points of particular attention are described. Then, a short time reconstructive surgery with a pmmc flap was started. We have proposed to the patient a pedicle pmmc flap for reconstruction because his age the. Applications of pmmc permanent magnet moving coil instruments are acknowledged to be the best type of all d. Pectoralis major myocutaneous flap in head and neck. Pmmc flap harvested from either the left or right anterior chest wall was used for reconstructing the. Indications and outcomes for pedicled pectoralis major.
Pdf pectoralis major myocutaneous flap for head and neck. Use of pectoralis major myocutaneous flap for resurfacing. The pmmc flap is reliable with less than 10% of the major complication rate requiring reoperation. Pdf pectoralis major myocutaneous flap in head and neck. Postoperative image with improved mouth opening and good cosmesis.
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. Rather than enjoying a good pdf similar to a cup of coffee in the afternoon, then again they juggled. This pdf is available for free download from a site hosted by medknow publications. The axial vessels can be better preserved, and hemorrhage reduced, by sufficiently undermining the incised skin and lifting the entire greater pectoral muscle. 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. 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 in head and neck reconstruction 1. Flap surgery is a technique in plastic and reconstructive surgery where any type of tissue is lifted from a donor site and moved to a recipient site with an intact blood supply. A modified pectoralis major myocutaneous flap technique with. Case presentation we present a 4yearold child with recurrent fibromatosis of the oropharyngeal region where the pmmc was used for reconstruction of the surgical defect and to the best of our knowledge is the youngest patient undergoing. In the measurement of direct currents and voltage ii. Ariyan 1979 work house flap for head and neck reconstruction regional pedicle flap 2. Reconstruction of the laryngopharynx bioline international. Pectoralis major myocutaneous flap oral and maxillofacial surgery.
Successful management of the cervicothoracic esophagus. At a minimum, special attention needs to be paid to vessel geometry and avoiding compression from the overlying pmmc flap. Experience with the pectoralis major myocutaneous flap for. Using pmmc flap alone for lining as well as cover has become an established procedure. Reconstruction for complex oromandibular facial defects. The vascular anatomy of the pectoralis major muscle and overlying skin and subcutaneous tissue was investigated in seventeen cadaver specimens by cannulation of the arterial supply and injection of contrast medium. Contemporary management of head and neck malignancy is a cumulative effort of new oncologic and reconstructive techniques. The available literature on pmmc flap reconstruction showed varying definition of. However, techniques in microvascular surgery have since evolved and recently free tissue transfer has played an important role in head and neck reconstruction. The action of these instruments is based on the motoring principle. Deltopectoral flaps also require second stage surgery for delaydivison of flap. The vascular anatomy of the pectoralis major myocutaneous.
Pmmc flap can also be used in combination with free flap to cover large soft tissue defects overlying a major vessel and in patients with high risk of wound dehiscence. The pectoralis major flap was first described in 1968 and later popularized for head and neck reconstruction by ariyan in 1979. Its use as a pedicled flap for extraabdominal applications other than those on the chest is less well described. Forehead flap was delayed after 6 weeks of surgery and final detachment and insetting was done in 7th week. A permanent magnet moving coil pmmc meter also known as a darsonval meter or galvanometer is an instrument that allows you to measure the current through a coil by observing the coils angular deflection in a uniform magnetic field. The pectoralis major myocutaneous pmmc flap has always been considered the workhorse flap for oral, head, and neck reconstruction. The aim was to evaluate the feasibility of pectoralis major myocutaneous pmmc flap in reconstruction of defects in the head and neck region. Deltopectoral and pectoralis musculocutaneous flap technique for. In this study, we have presented our experience with the use of bipaddle pectoralis major myocutaneous pmmc flap as a single stage. The resection as well as reconstruction was done by the same team consisting only of general surgeons. Pectoralis major myocutaneous flap pmmc with deltopectoral flap. Pectoralis major myocutaneous flap for reconstruction of. The need of the hour is a versatile flap which has the advantages of both a regional flap viz.
Standard technique for harvesting the pmmc flap as. Pmmc with single stage deltopectoral dp composite flap. We report to our knowledge for the first development of breast cancer in the pmmc flap in a 79 year old patient, who had undergone several operations in the past for recurring squamous cell. Pmmc flap revisited and its clinical outcome in 150. Even in our institution, free tissue transfers are carried out on a regular basis, but there is a. This technique is highly valued because it can transplant a large amount of wellvascularized tissue, but its vascular pattern seems to have been characterized by a simple axial pattern without adequate investigation. Permanent magnet moving coil instruments pmmc the permanent magnet moving coil instruments are most accurate type for direct current measurements. Pmmc flap revisited and its clinical outcome in 150 patients. Computed tomography in evaluation of postoperative head. Combined dp and pmmc flap technique was useful for cervical esophageal reconstruction after. The conventional technique of harvesting a pmmc flap involves a single vascular supply from the pectoral branch of the thoracoacromial artery.