Pectoralis Major Myocutaneous Flap Reconstruction in Head-and-Neck Malignancy – Experience from a Tertiary Care Center

Background: The pectoralis major myocutaneous (PMMC) flap as a pedicle flap is still a reliable option to reconstruct thedefects following major oncological resections of head-and-neck cancer. It is the workhorse in centers where the facilities forfree tissue transfer are not available. Our aim is to assess the complications of PMMC flap reconstruction.Materials and Methods: A retrospective analysis of records of 17 patients who underwent reconstruction with PMMC flapas a pedicle flap for head-and-neck malignancies from 2013 to 2019 in the Department of Surgical Oncology, GovernmentThoothukudi Medical College Hospital, Thoothukudi, was performed.Results: Records of 17 patients who received PMMC flap were taken for analysis. Of those 17 patients, three were female. Ofthose 17 patients, 15 had oral cavity malignancy and 2 had malignant parotid tumors. PMMC was used to cover the mucosaldefect in eight patients, skin defect in two patients, and both in seven patients as bipaddle flap. None of the patients had a totalloss of flap, but one case of marginal necrosis and three cases of partial intraoral flap dehiscence were noted. Oral cavity defectaccounts for 15 flaps and the remaining 2 were done to reconstruct the defect following resection of the malignant parotid tumor.Conclusion: In centers without free tissue transfer facility, PMMC is still the gold standard flap in head-and-neck reconstruction.The morbidity is very minimal in experienced hands.

Level 3 Axillary Nodal Status in the Absence of Metastatic Disease in Level 1 and 2 Axillary Node in Carcinoma Breast – A Retrospective Analysis

Introduction: The intention of axillary lymph node dissection (ALND) is to stage the axilla precisely for prognostic information.This study is to assess the possibility of skip lesion in Level 3 in the absence of disease in Level 1 and 2 which may help inundertaking randomized controlled study to avoid Level 3 nodal dissection in our patients.Materials and Methods: Retrospective analysis of 60 patients who underwent surgery for invasive breast cancer from October2013 to October 2019 in the Department of Surgical Oncology, Government Thoothukudi Medical College Hospital, Thoothukudi,was performed.Results: About 33.3% of patients (20) were disease free in the axilla and the remaining 66.7% (40) had nodal involvement. Ofthose 39 patients who had nodal involvement in Level 1 and 2, 15 were found to have the disease in 4 or more nodes, 24 hadthe disease in <4 nodes. Totally 16 patients had metastases in Level 3 nodes. There is a 60% chance of involvement of Level3 when there is 4 or more nodal positivity in Level 1 and 2 and it drops to 25% if the involved nodal count becomes <4. Onepatient had skip lesion in Level 3 (4.8%) without disease in Level 1 and 2.Conclusion: Since there has been a dearth of randomized studies about levels of nodes to be addressed in ALND and studiesabout skip lesion in Level 3 from our country, we urge the need for more studies probably multicentric, regarding the extent ofALND. Until then, it may be fruitful to do complete ALND up to Level 3 for the better staging of the axilla.