Choudhury Arpan, Laxmidhar Murtuza I, Ahirwar Neelam
Department of Surgical Oncology, Apollo Hospitals Ahmedabad, Plot No.1 A, Bhat GIDC Estate, 382428 Gandhinagar, India.
Indian J Otolaryngol Head Neck Surg. 2023 Sep;75(3):2172-2176. doi: 10.1007/s12070-023-03842-x. Epub 2023 May 6.
To evaluate the current role of pectoralis major (PM) flap including the reasons for selecting it over free flaps.
All patients who underwent PM flap at Apollo Hospitals Ahmedabad during the 3-year period from January 2020 to December 2022 were included. Patient demographics, tumour characteristics and complications were studied and reasons for selecting pectoralis major flap were analyzed. Data was entered in Microsoft excel spreadsheet and analyzed using online statistical calculators. The p value of < 0.05 was considered statistically significant.
57 patients underwent reconstruction with PM flap while 154 patients underwent free flap reconstruction. 54 were male and 3 were female. Median age was 51 years. PM flap was used for intraoral lining in 25 patients, and it was bilobed in 26 patients with full thickness cheek defect. Most common complication was wound infection seen in 10 patients. 5 patients developed marginal necrosis of the flap and 5 had donor site wound dehiscence. No complete flap loss was seen. During the same period, 15/154 (9.74%) patients with free flaps developed complete flap necrosis and this was statistically significant (p = 0.012). Reasons for choosing PM flap were also analyzed. 14 patients had major comorbidities, 18 had extensive disease, in 5 patients it was used for salvage post free flap failure, while 10 previously treated patients had unavailability of suitable vessels for anastomosis. 12 patients underwent PM flap due to financial constraints.
Thus, PM flap is not obsolete and continues to maintain its place in head and neck reconstruction.
评估胸大肌（PM）皮瓣目前的作用，包括选择其而非游离皮瓣的原因。
纳入2020年1月至2022年12月这3年期间在艾哈迈达巴德阿波罗医院接受PM皮瓣手术的所有患者。研究患者的人口统计学特征、肿瘤特征及并发症，并分析选择胸大肌皮瓣的原因。数据录入微软Excel电子表格，并使用在线统计计算器进行分析。p值<0.05被认为具有统计学意义。
57例患者接受了PM皮瓣重建，154例患者接受了游离皮瓣重建。54例为男性，3例为女性。中位年龄为51岁。25例患者使用PM皮瓣进行口腔内衬，26例全层颊部缺损患者使用双叶PM皮瓣。最常见的并发症是10例患者出现伤口感染。5例患者出现皮瓣边缘坏死，5例供区伤口裂开。未出现皮瓣完全坏死。同期，154例游离皮瓣患者中有15例（9.74%）发生皮瓣完全坏死，这具有统计学意义（p = 0.012）。还分析了选择PM皮瓣的原因。14例患者有严重合并症，18例有广泛病变，5例用于游离皮瓣失败后的挽救手术，而10例先前接受过治疗的患者没有合适的血管用于吻合。12例患者因经济限制接受了PM皮瓣手术。
因此，PM皮瓣并未过时，在头颈部重建中仍占有一席之地。
