Research Of Pectoralis Major Myocutaneous Flap With Abundant Tissue In Repair Of Head And Neck Defects

Objective To explore the surgical technique of pectoralis major myocutaneous flap(PMMF)with abundant tissue in the treatment of head and neck tumor resection defect and the treatment and prevention of postoperative complications.Methods Summarizing 23 cases(24 sides)from January 1,2008 to October 1,2014,which were repaired the defect of head and neck tumor with PMMF with abundant tissue(including overweight / Obese male patients and female patients)in the First Affiliated Hospital of Anhui Medical University,the treatment experience of corresponding postoperative complications.For the overweight / obese male and / or female patients,the PMMF tissue volume is abundant.A variety of head and neck defects could be repaired with the improved methods of design and preparation.The skin paddle of PMMF is usually designed in the inside and underside surface of the areola.The degree should not be less than 45 ° between the skin,subcutaneous tissue and the surface of the pectoralis major fascia;cutting off the medial,inferior and lateral pectoralis major muscle to rib periosteum and intercostal muscle surface at 1cm ouside from where the subcutaneous tissue and pectoralis major fascia attached to.And then peeling the pectoralis major muscle to the surface of the pectoralis major muscle;finding out the vascular pedicle of PMMF through the method of perspective;pulling the PMMF to the defect,first fixes muscle,then stitichs the skin and the defect of the skin or mucous membrane,after repairing defects,the potential space aroud the PMMF needs negative pressure drainage.Results 1 of 23 cases of obese patients PMMF was injuryed thoracic apex artery accidentally during the operation,so we had to prepare the other side of the PMMF.All of the 23 PMMFs survived,and only distal part of one of them was necrotic and healed after dressing.The group of 3 cases of infection by the formation of pharyngeal leakage,secondary healing after dressing;part of flap skin and reception site skin of one case splited,secondary healing after dressing;the donor site of one case was found,healing soon after remoting congestion timely.Conclusion Whether overweight/obese male patients or female patients,although PMMF is bloated,PMMF and wound can still heal,as its constant blood vessel and rich blood supply,as long as locating correctly and protecting the vessels,close monitoring and nursing care and dealing with complications in time.Therefore PMMF is still an very important means of reconstruction of head and neck defects.