Utility of Bipaddle Pectoralis Major Myocutaneous Flap Reconstruction for Single Stage Reconstruction in Locally Advanced Oral Cancer

Abstract

Bhavesh Bang, Hemant Thanna* and Manish Kaushal

Back ground: India has the unfortunate distinction of being the oral cancer capital of the world. Most oral cancers in India present in the advanced stages of their disease (TNM stage III and IV) (Tumor (T), Node (N), and Metastasis (M) staging), as compared to the West, where the majority of patients present in stage I and II. Advanced oral cancer poses challenges not only with respect to resection but also in terms of reconstruction. While microvascular free tissue transfer is the standard of care now at most western centres, the Pectoralis Major Myo Cutaneous (PMMC) flap still forms the workhorse for oral cavity reconstruction following ablative surgery for cancer at most centres in India. For through-and-through defects of the oral cavity, the approach has been to perform the PMMC flap for the mucosal lining and a second fasciocutaneous flap for the outer cover. This, however, makes the surgery a two-stage procedure, increasing the morbidity.

Method: We present our series of 20 patients with locally advanced oral cancer treated by surgery, resulting in full-thickness defects of the oral cavity, who were reconstructed using a bipaddle PMMC flap, offering a single-stage reconstruction of the defect. This was a prospective observational study, conducted over one year.

Conclusion: Our study upholds the utility of doing a bipaddle PMMC flap in advanced oral carcinoma as previously reported in the literature.