COMPLICATIONS OF THE PECTORALIS MAJOR OSTEOMYOCUTANEOUS FLAP USED FORHEAD AND NECK RECONSTRUCTION

The analysis of the complications of the pectoralis major osteomyocuta neous flaps used for head and neck reconstruction and how to prevent t hem is the subject of this report. Ten patients with squamous cell car cinoma of the floor of the mouth who had undergone segmental glossecto my and mandibulectomy, radical uni- or bilateral cervical lymphadenect omy, and immediate reconstruction with the pectoralis major osteomyocu taneous flaps were evaluated. Neither partial nor total necrosis of th e myocutaneous segment occurred in any patient but rib necrosis develo ped in five. An oral fistula occurred in four patients exposing the ju nction of the rib with the mandible. There were three cases of flap ne crosis of the neck dissection. Two patients developed pneumothorax. Th e overall complication rate was 66.7%. Although this surgery requires major intraoral excision, the tumor is exophytic with previous infecti on and the patients' general condition debilitated, the incidence of c omplications is high. Despite the high morbidity, the pectoralis major myocutaneous flap remains a useful adjunct for head and neck reconstr uction. The flap is versatile and for many patients repair with a free flap is impossible because of contraindications such as previous irra diation, problems with the vascular anastomoses, advanced age and poor general condition. It also aids in the surgical training of new speci alists.