Vascular compromise of the pectoralis major musculocutaneous flap in head and neck reconstruction.

In head and neck reconstructive surgery, the pectoralis major musculocutaneous flap is a major reconstructive tool, both in primary as well as secondary reconstructions. In a few cases the authors have been able to demonstrate that when the pectoralis major musculocutaneous flap is translocated to the mouth through a noncompromised neck tunnel, as is done for head and neck reconstructions, the taut lateral pectoral nerve is seen to compress the vascular pedicle of the flap, adversely affecting its vascularity, which can lead to partial or total necrosis of the flap. The authors explain this feature, very specific to this flap, with the help of a prospective series of patients.

Total oral reconstruction for cancers associated with advanced oral submucous fibrosis.

The progression of submucous fibrosis to oral cancer is well established. This condition in an advanced stage causes progressive trismus. Oral cancers associated with severe submucous fibrosis (interincisor distance [IID] < or = 1.5 cm) require bilateral buccal mucosal reconstruction after tumor excision. After wide excision of the tumor, a regional flap is used to reconstruct the buccal mucosal loss on that side. The opposite buccal mucosa, afflicted by advanced submucous fibrosis, is released at the same time to open the mouth and is resurfaced by an ipsilateral, inferiorly based nasolabial flap. This helps to rehabilitate the oral cavity completely and to prevent the recurrence of trismus. In 18 months, 12 patients underwent total reconstruction of intraoral tumors associated with submucous fibrosis. The average preoperative IID was 0.875 cm. All patients had inferiorly based, two-stage nasolabial flaps for submucous fibrosis reconstruction. The average pain-free postoperative IID was 3.13 cm.