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OBJECTIVES & AIMS: To determine whether the known risk factors such as comorbidities like diabetes &hypertension, or smoking increase the complications of flap transfer. Whether the type of flap transfer has any effect on flap related complications or onpost-operative rehabilitation of patients.METHODOLOGY:This is a retrospective study conducted at GCS Hospital, Ahmedabad, between January 2020to July 2021. Sample size is 63 patients with oral cavity cancer, out of which 21 underwentPMMC flap reconstruction, 21 underwent free ALT free flap reconstruction and 21underwent Radial free flap reconstruction.CONCLUSION:Risks have not increased complications in free flap or PMMC group in our study. Variousother studies have similar results however a larger patient pool may be needed to assess them.Though the flap related complications & donor site related complications are more withPMMC flap as compared to ALT & Radial free flap, statistically there is no significantdifference. Also, in the functional post-op outcomes there is no statistically significantdifference with PMMC flap, ALT free flap or Radial free flap.
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Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a well-recognized public health problem throughout theworld. The evolution of new genetically distinct community-acquired and livestock-acquired MRSA and extended resistance toother non-β-lactams including vancomycin has only amplified the crisis. This paper presents data on the prevalence of MRSAand resistance pattern to other antibiotics on the selected specimen from burn patients.Materials and Methods: This is a prospective study conducted in the burn unit of Shyam Shah Medical College and SanjayGandhi Memorial Hospital, Rewa (M.P.), from June 2018 to May 2019, where all patients with flame and scald burns wereincluded in the study who had up to a second degree or partial-thickness burns.Results: A total of 558 patients were admitted in the burn unit throu`ghout the year, the age ranged from 2 months to 85 years.About 56.10% were females and 43.90% were males. Pseudomonas aeruginosa (37.5%) was the most common isolatefollowed by S. aureus (18.75%). The prevalence of MRSA was 57.14% but all the MRSA isolates showed 100% sensitivity tovancomycin and linezolid closely followed by piperacillin and tazobactam combination. The prevalence of methicillin resistanceoverall among S. aureus and Staphylococcus epidermidis was found to be 51.72%.Conclusion: MRSA is prevalent among the burn wounds but is 100% sensitive to vancomycin and linezolid. To ensure earlyand appropriate therapy, routine microbiological surveillance and a regular update of their antimicrobial susceptibility patterncould help in the prevention of development of multidrug resistance.
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Objective@#To compare the pedicled supraclavicular artery island flap (SCAIF) and the pectoralis major myocutaneous flap (PMMF) for oral reconstruction after cancer resection.@*Methods@#This is a retrospective study from May 2007 to May 2017. Sixty-one patients from the Jiangxi University of Traditional Chinese Medicine and the First Affiliated Hospital of Nanchang University, were included. All the patients underwent oral squamous cell carcinoma resection and pedicled flap reconstruction. Sixteen patients were performed SCAIFs (group A), and 45 were performed PMMFs (group B). The flap survival rate, flap size, flap preparation time, the presence of scar hyperplasia, pigmentation and dysfunction (temporary or permanent) were compared between these two groups.@*Results@#The survival rate of flaps in group A was 93.75% (15/16), and the survival rate of flaps in group B was 95.56% (43/45). There was no statistically significant difference in the survival rate of flaps, the average skin flap size or flap produce time between these 2 groups. There were no scar hyperplasia, pigmentation and dysfunction was observed in group A. However, scar hyperplasia (n=11), pigmentation (n=10) and dysfunction (n=12) occurred in group B. The difference was statistically significant (P<0.05).@*Conclusions@#This study suggests that SCAIF is more reliable, and brings more satisfied outcome, when compared with the PMMF.
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We report two cases with postoperative sternal osteomyelitis after coronary artery bypass graft (CABG), in whom successful two-stage reconstruction was performed via negative pressure wound therapy (NPWT) and pectoralis major myocutaneous flaps. Two patients underwent CABG using bilateral internal thoracic arteries, after which they had surgical site infection (SSI). The intractable wound did not heal with irrigation and NPWT. Then, sternal osteomyelitis was observed via magnetic resonance imaging (MRI), so we planned two-stage reconstruction. The first stage of treatment consisted of complete debridement (including removal of sternal wires and necrosectomy of soft tissue and sequestrum) and application of NPWT until the remission of inflammation. The second stage consisted of wound closure with pectoralis major myocutaneous advancement flaps. After wound closure, the two patients were given 2 months of oral antibiotics, and the postoperative results were good. Two-stage reconstruction with NPWT and pectoralis major myocutaneous flaps results in excellent clinical outcome. In the first stage, the key to the successful management of postoperative sternal osteomyelitis is infection control. This includes surgical debridement and wound-bed preparation with NPWT. The pectoralis major myocutaneous flap technique is brief and does not require a second cutaneous incision or an intact internal thoracic artery. In conclusion, the pectoralis major myocutaneous flap is a useful option in two-stage reconstruction after CABG.
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Objective To explore the clinical effects of modified pedicled pectoralis major myocutaneous flaps(PMMFs) in repairing postoperative defects following head and neck malignant tumor radical operation.Methods Twenty-eight patients with surgical defects after head and neck malignant tumor operation in this hospital from September 2013 to January 2017 were selected and performed the repairing reconstruction by modified PMMFs,then observed and followed up for the survival of the flaps.Results All 28 cases were followed-up for 3-36 months,all modified PMMFs survived.Using modified PMMFs to repair surgical defects following head and neck malignant tumor operation had the advantages of high survival rate and less trauma;meanwhile the swallow and language function could obtain the maximal recovery.Conclusion Using modified PMMFs to repair surgical defects following head and neck malignant tumor operation has good clinical curative effect and is worth clinical application.
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Objective To summarize experience in pectoralis major myocutaneous (PMMC) flap reconstruction for patients undergoing head and neck surgeries. Methods We conducted a retrospective study to analyse the clinical data of 20 patients who had PMMC flap reconstruction in a head and neck surgery from March 2011 to June 2016. All patients were male,with the average age of 54 years(ranging from 27 to 71 years). The PMMC flaps of all patients survived after the surgery. Only one patient developed pharyngocutaneous fistula ,and was recovered after treatment with incision dressing. Among follow?ups for 2 to 24 months,all patients got well recovered,the swallowing and communication functions normal communication and the appearance a satisfactory. good looking. Conclusion PMMC renders effective flathe flap reconstruction with broad clinical application value is an optimal choice for patients underwent head and neck surgery with muscle or skin defect,especially for those who had postoperative radiotherapy because of its rich blood supply and it has a lot of affluent tissues,fmore flexibility inle application and higher survival rate. So it is highly applicable,especially for grass?roots hospitals.
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Background and Objective: Myocutaneous flaps play a prominent role in the immediate reconstruction of surgical defects following ablative oncological procedures in head and neck. Pectoralis major myocutaneous flap is one such flap which is probably the most reliable and commonly used flap in orofacial reconstruction of tumour and trauma related defects of oral and maxillofacial region. The aim of the current study is to check the versatility of Pectoralis major myocutaneous flap in reconstruction of head and neck cancers. Methods: The prospective study was conducted among the patients, who were treated for ablative surgery of head and neck cancer in whom reconstruction was done using Pectoralis major myocutaneous flap in our department of oral and maxillofacial surgery, VS Dental College, Bengaluru between 2012 to 2015. A total of 8 patients were included in this study where primary reconstruction was carried out with Pectoralis major myocutaneous flap. Results: The results of this study clearly demonstrate that Pectoralis major myocutaneous flap can be used for orofacial defects with high degree of reliability and minimal complications. The test showed that the observed difference for partial necrosis and partial dehiscence at different time duration was statistically not significant. Conclusion: It appeared in this study that, functional and aesthetic results were consistently satisfactory with minimal complications. In the current era of microvascular surgeries this flap still remains a valuable tool in head and neck reconstruction.
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Objective To summarize the clinical outcomes of pectoralis major myocutaneous flap for repairing large defects in oral and maxillofacial area after resection of malignant tumor. Methods The clinical data of 27 patients underwent resection of malignant tumor in oral and maxillofacial area and reconstructed with pectoralis major myocutaneous flap were collected in our hospital from August 1998 to January 2015. The pectoralis major myocutaneous flaps were harvested with sizes ranging from 6 cm × 4 cm to 11 cm × 9 cm. The major myocutaneous flaps were used to reconstruct the defects of oral mucosa in 26 cases, and flap was used to reconstruct the defect of facial skin in 1 case. Seventeen major myocutaneous flaps reached the neck via the subclavicular tunnel, the other 10 were transferred over the clavicle. Results After surgery, 20 flaps (74.1%) were survived completely, 6 were partial necrosis (22.2%) and one was total necrosis (3.7%). Thirteen cases showed postoperative complications (48.1%), in which 10 cases were wound infection (37.0%), including 8 patients with infection at the recipient site and 2 patients with infection at the donor site. The wound infection was found in all of 7 patients with flap necrosis. The other complications included wound dehiscence in 1 patient (3.7%), neck hematoma in 1 patient (3.7%), and lung infection in 1 patient (3.7%). Conclusion In order to avoid the flap necrosis and reduce wound infection at the recipient site, the major myocutaneous flap should be designed based on the characteristics of blood supply, and the vascular pedicle should be protected carefully in the operation.
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Femenino , Humanos , Masculino , Carcinoma Mucoepidermoide , Carcinoma de Células Escamosas , Fibrosarcoma , Fístula , Colgajos Tisulares Libres , Hematoma , Neoplasias de la Boca , Necrosis , Complicaciones Posoperatorias , Estudios RetrospectivosRESUMEN
Reconstruction with free flaps has become the choice of reconstruction for most patients with head and neck defects. However, pedicled flaps, such as pectoralis major pedicled flap and latissimus dorsi pedicled flap (LDPF), can also be used instead in selected patients. We performed LDPFs in 6 patients from November 2007 to September 2009. Five of the patients were females with either vascular diseases or large skin defects, or they were highrisk old patients. One male patient received LDPF as a salvage after tongue reconstruction with a free flap failed. Various types of head and neck defects were effectively managed with LDPF without complications. LDPF can be one option for head and neck reconstruction especially in patients who may hve high risk in undergoing free flap reconstruction.
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Femenino , Humanos , Masculino , Colgajos Tisulares Libres , Cabeza , Cuello , Piel , Colgajos Quirúrgicos , Lengua , Enfermedades VascularesRESUMEN
BACKGROUND AND OBJECTIVES: Pectoralis major myocutaneous flap(PMMCF) is a workhorse flap of head and neck reconstruction and it has four types depending on its nature of vascular pedicle. True island type PMMCF has many advantages over conventional muscular type, but reports on this type of flap and its advantages are lacking. Material and METHOD: Fifty two PMMCF(50 patients) used for head and neck reconstruction between 1992 and 1998 were reviewed retrospectively. There were 16 muscular type and 36 true island type PMMCF. We compared the incidence of complication between two groups. RESULT: Six marginal necrosis(less than 20%) and 1 major necrosis(more than 50%) developed in 16 muscular type PMMCF. However in 36 true island type PMMCF, 1 marginal necrosis and 2 major necrosis developed. CONCLUSION: True island type PMMCF has the following advantages over muscular type. 1. True island type has 3-4 cm gain in length. 2. Flap could be harvested at more cephalic portion of the chest. 3. Unwanted tension of the flap could be avoided. 4. Vascular pedicle is not compressed between skin and clavicle. 5. The rotation of vascular pedicle is natural without kinking. 6. Ugly bulge over clavicle is absent postoperatively. 7. This type could be used regardless of types of neck dissection.
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Clavícula , Cabeza , Incidencia , Colgajo Miocutáneo , Cuello , Disección del Cuello , Necrosis , Estudios Retrospectivos , Piel , TóraxRESUMEN
The treatment of head and neck cancer with radiotherapy and radical neck dissection has many well recognized complications. Radiotherapy in therapeutic doses can produce devascularization and weakening of bone. Radical neck dissection results in altered mechanics of the shoulder girdle and a normally balanced forces acting on the clavicle. However, there are no reports elaborating on the unusual case of clavicle fracture which is considered to have resulted from pectoralis major myocutaneous flap (PMMCF). We reviewed 169 cases treated with radical neck dissection and 45 patients treated with PMMCF between 1992 and 1998, retrospectively. We could find three cases of clavicle fracture all of whom underwent radical neck dissection, PMMCF and postoperative radiotherapy on the side of fracture. The type of PMMCF was island PMMCF. Fractures were noted 1-3 years postoperatively and all fractures were noted on medial portion of the clavicle. Island type PMMCF was considered as one of the predisposing factors of clavicular fracture. Devascularization after stripping of periosteum and altered mechanics of the clavicle following resection of clavicular head of pectoralis major muscle may contribute to developing a rare complication in addition to the effect of radiotherapy and radical neck dissection.
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Humanos , Causalidad , Clavícula , Cabeza , Neoplasias de Cabeza y Cuello , Mecánica , Colgajo Miocutáneo , Disección del Cuello , Periostio , Radioterapia , Estudios Retrospectivos , HombroRESUMEN
BACKGROUND: The comparison of information and complication after pharyngoesophageal reconstruction using the forearm free flap and pectoralis major myocutaneous flap was rarely reported. OBJECTIVES: To compare the information(duration of the procedure, nasogastric tube feeding and hospital stay etc) and complications after pharyngoesophageal reconstruction using the forearm free flap and pectoralis major myocutaneous flap, we reviewed the records of 19 patients with squamous cell carcinoma of the hypopharynx. MATERIALS: The records of 19 patients with squamous cell carcinoma of hypopharyx between June 1989 and November 1995 at Chungnam National University Hospital were reviewed retrospectively. Ten of 19 patients were reconstructed with forearm free flap and the others were reconstructed with pectoralis major myocutaneous flap. RESULTS: In 10 patient using forearm free flap, the duration of procedure, the duration of hospital stay, duration of nasogastric tube feeding and viability of flap were 13.7 hours, 38.5 days, 24 days and 80% respectively. In 9 patients using pectoralis major myocutaneous flap, the duration of procedure, the duration of hospital stay, the duration of nasogastric tube feeding and viability of duration were 7.38 hours, 29.1 days, 19 days and 88.9% respectively. There was no significant difference in complications between the groups. CONCLUSION: The pectoralis major myocutaneous flap was slightly superior to forearm free flap in aspect of the duration of procedure, hospital stay, duration of nasogastric tube feeding and viability. There was no statistically significant difference of complications. But we think that the more cases were required to compare the forearm free flap and pectoralis major myocutaneous flap.
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Humanos , Carcinoma de Células Escamosas , Nutrición Enteral , Antebrazo , Colgajos Tisulares Libres , Neoplasias Hipofaríngeas , Hipofaringe , Tiempo de Internación , Colgajo Miocutáneo , Estudios RetrospectivosRESUMEN
BACKGROUND: Despite recent advances in radiation therapy and chemotherapy, surgical procedures remain the primary modality of head and neck cancer therapy. Adequate surgical resection frequently requires the removal of significant amounts of tissue. In addition to the prolongation of life, the restoration of a functional aerodigestive tract is the primary concern of the reconstructive surgeon. OBJECTIVE: With the above in mind, we have evaluated our experience with head and neck reconstruction using various flaps. MATERIALS AND METHODS: The medical records of 95 patients who underwent 112 reconstructive surgeries in the head and neck area from 1983 to 1996 in Seoul National University Hospital were reviewed. Results were evaluated with emphasis on the functional aspect and postoperative course. RESULTS: Successful transfer using PMMC flaps were achieved in 100%, 93% in skin defect and oral/oropharyngeal defect, respectively. In pharyngoesophageal reconstruction, free and visceral flaps had higher success rates and lower complication rates than pectoralis major myocutaneous(PMMC) flaps(75% vs. 64%, 64% vs. 25%). The average completion time to oral intake in pharyngoesophageal reconstruction was within 2 weeks using free and visceral flaps, but within 29 days using PMMC flaps. CONCLUSIONS: PMMC flap is still a workhorse for head and neck reconstruction. Reconstruction with PMMC flap is adequate for skin, oral or oropharyngeal reconstruction, but inadequate for pharyngoesophageal reconstruction especially for circumferential defect. Those patients reconstructed with visceral flaps were able to tolerate oral feedings sooner and were less likely to have local complications than those with PMMC flaps. Thin myocutaneous flaps such as platysma flap can be used for myomucosal defect of oral cavity as adequately as free flaps.
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Humanos , Quimioterapia , Colgajos Tisulares Libres , Neoplasias de Cabeza y Cuello , Cabeza , Cuidados para Prolongación de la Vida , Registros Médicos , Boca , Colgajo Miocutáneo , Cuello , Seúl , PielRESUMEN
The vessels and nerves in the pectoacromial region were dissected under an operative microscope on 50 human specimens. The main blood supply of this region comes from the thoracoacromial artery. Its deltoid, pectoral, and clavicular branches all have secondary branches to the pectoralis major. In 94% of the cases, the .deltoid branch sends out a cutaneous branch known as the thoracoacromial cutaneous branch. Its external caliber is 1.22mm in average and it distributes over the cutaneous region covering the anterior portion of the del-toideus, the subclavian fossa, and the upper portion of the pectoralis major with an average area of 80.63cm2.An extended pectoralis major myocutaneous flap can be designed taking the thoracoacromial artery or its deltoid branch as its pedicle. This myocutaneous flap can contain an axial skin flap supplied by the thoracoacromial cutaneous branch.