Pectoralis major myocutaneous flap for faringeal defects reconstruction. Case report
Abstract Introduction: Pharyngocutaneous fistula after total laryngectomy (TL) remains a hardly frequent complication especially after radiotherapy. When conservative measures fail, reconstructive procedures are necessary. Our institution has adopted the pharyngeal interposition graft (PIG) using a pectoralis major myocutaneous flap (PMMC), which has adequate blood flow, for treatment post-irradiation pharyngocutaneous fistula. Description: We present a case-patient with a pharyngocutaneous fistula after TL that requires an externsive reconstruction by PMMC flap and the important role of hyperbaric oxygen therapy in the management of radiation-induced injury. Conclusions: In this era of microvascular reconstruction, the PMMC flap can safely be used for reconstruction of head and neck defects, providing cover to pharyngeal repair following salvage laryngectomy in patients who are high risk for free flaps after organ preservation protocols or patiens with a history of vascular disease.
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3. Kekatpure VD, Trivedi NP, Manjula BV, et al. Pectoralis major flap for head and neck reconstruction in era of free flaps. Int J Oral Maxillofac Surg 2012;41:453-7.
4. Guimarães AV, Aires FT, Dedivitis RA, Kulcsar MAV, Ramos DM, Cernea CR, Brandão LG (2016) Efficacy of pectoralis major muscle flap for pharyngocutaneous fistula prevention in salvage total laryngectomy: a systematic review. Head Neck E2317–E2321.
5. Okamoto I, Tsukahara K, Shimizu A, Sato H. Post-operative complications of salvage total laryngectomy forpost-radiotherapy recurrent laryngeal cancer using pectoralis major myocutaneous flaps. Acta Otolaryngol. 2019; 139:167–71.
6. Ariyan S. The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck. Plast Reconstr Surg 1979;63:73–81.
7. Teo KG, Rozen WM, Acosta R. The pectoralis major myocutaneous flap. J Reconstr Microsurg. 2013;29:449–456.
8. Liu MY, Liu WW, Yang YH, et al. Pectoralis major myocutaneous flap for head and neck defects in the era of free flaps: harvesting technique and indications. Sci Rep 2017;7:46256.
9. Righini C, Lequeux T, Cuisnier O, Morel N, Reyt E. The pectoralis myofascial flap in pharyngolaryngeal surgery after radiotherapy. Eur Arch Otorhinolaryngol. 2005;262:357–361.
10. Spiegelberg L, Djasim UM, van Neck HW, Wolvius EB, van der Wal KG. Hyperbaric oxygen therapy in the management of radiation-induced injury in the head and neck región: a review of the literatura. J Oral Maxillofac Surg. 2010;68:1732-9.
11. Francis A, Baynosa RC. Hyperbaric Oxygen Therapy for the Compromised Graft or Flap. Adv Wound Care (New Rochelle). 2017;6(1):23–32.
12. Ravi P, Vaishnavi D, Gnanam A, Krishnakumar Raja VB. The role of hyperbaric oxygen therapy in the prevention and management of radiation-induced complications of the head and neck - a systematic review of literature. J Stomatol Oral Maxillofac Surg. (2017) 118:359–62.
2. Leite AK, de Matos LL, Belli M, et al. Pectoralis major myocutaneous flap for head and neck reconstruction: risk factors for fistula formation. Acta Otorhinolaryngol Ital. 2014;34:389–93.
3. Kekatpure VD, Trivedi NP, Manjula BV, et al. Pectoralis major flap for head and neck reconstruction in era of free flaps. Int J Oral Maxillofac Surg 2012;41:453-7.
4. Guimarães AV, Aires FT, Dedivitis RA, Kulcsar MAV, Ramos DM, Cernea CR, Brandão LG (2016) Efficacy of pectoralis major muscle flap for pharyngocutaneous fistula prevention in salvage total laryngectomy: a systematic review. Head Neck E2317–E2321.
5. Okamoto I, Tsukahara K, Shimizu A, Sato H. Post-operative complications of salvage total laryngectomy forpost-radiotherapy recurrent laryngeal cancer using pectoralis major myocutaneous flaps. Acta Otolaryngol. 2019; 139:167–71.
6. Ariyan S. The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck. Plast Reconstr Surg 1979;63:73–81.
7. Teo KG, Rozen WM, Acosta R. The pectoralis major myocutaneous flap. J Reconstr Microsurg. 2013;29:449–456.
8. Liu MY, Liu WW, Yang YH, et al. Pectoralis major myocutaneous flap for head and neck defects in the era of free flaps: harvesting technique and indications. Sci Rep 2017;7:46256.
9. Righini C, Lequeux T, Cuisnier O, Morel N, Reyt E. The pectoralis myofascial flap in pharyngolaryngeal surgery after radiotherapy. Eur Arch Otorhinolaryngol. 2005;262:357–361.
10. Spiegelberg L, Djasim UM, van Neck HW, Wolvius EB, van der Wal KG. Hyperbaric oxygen therapy in the management of radiation-induced injury in the head and neck región: a review of the literatura. J Oral Maxillofac Surg. 2010;68:1732-9.
11. Francis A, Baynosa RC. Hyperbaric Oxygen Therapy for the Compromised Graft or Flap. Adv Wound Care (New Rochelle). 2017;6(1):23–32.
12. Ravi P, Vaishnavi D, Gnanam A, Krishnakumar Raja VB. The role of hyperbaric oxygen therapy in the prevention and management of radiation-induced complications of the head and neck - a systematic review of literature. J Stomatol Oral Maxillofac Surg. (2017) 118:359–62.
Sanz-Sánchez, C. I., Kraemer-Baeza, E., Flores-Carmona, E., Aguilar-Conde, M. D., & Cazorla-Ramos, O. E. (2020). Pectoralis major myocutaneous flap for faringeal defects reconstruction. Case report. Revista ORL, 12(1), 89–95. https://doi.org/10.14201/orl.23519
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