Lymphoscintigraphy in pectoralis major myocutaneous flaps.

Myocutaneous flaps are used widely in the surgical treatment of advanced cancers, which in the past had been thought to be inoperable. Tumor recurrences are expected more frequently in these patients. Recurrent tumors may spread locally and to the regional areas via lymphatics and vessels. However, the lymphatic spread may differ in cases where myocutaneous flaps are used for reconstruction. This study is based on five patients with head and neck cancer who underwent reconstruction with myocutaneous flaps. Technetium Tc99m-labeled dextran was used to demonstrate the lymphatic flow, and technetium Tc99m rhenium sulfur colloid was used to show the lymph nodes of the neck and pectoralis major myocutaneous flap. Our findings show that the newly formed lymphatics do not pierce the fibrotic border of the donor and recipient sides. Lymphatic metastasis may occur to the internal mammary nodes through the myocutaneous flap only after recurrent tumors have invaded the myocutaneous flap directly.