Can Lateral Thoracic Artery Preservation Improve Results in Large PMMC Flaps? - Our Experience of 61 Cases from Northern India

Pranav Mohan Singhal; Pinakin Patel; Kama Kishor Lakhera; Agil Babu; Aishwarya Chatterjee; Suresh Singh; Bhoopendra Singh Gora; Naina Kumar Agarwal

doi:10.1007/s12070-023-04123-3

Can Lateral Thoracic Artery Preservation Improve Results in Large PMMC Flaps? - Our Experience of 61 Cases from Northern India

Indian J Otolaryngol Head Neck Surg. 2024 Feb;76(1):182-190. doi: 10.1007/s12070-023-04123-3. Epub 2023 Aug 4.

Authors

Pranav Mohan Singhal¹, Pinakin Patel¹, Kama Kishor Lakhera¹, Agil Babu¹, Aishwarya Chatterjee¹, Suresh Singh¹, Bhoopendra Singh Gora¹, Naina Kumar Agarwal¹

Affiliation

¹ SMS Medical College, Jaipur, Rajasthan India.

PMID: 38440499
PMCID: PMC10909003 (available on 2025-02-01)
DOI: 10.1007/s12070-023-04123-3

Abstract

Introduction: Pectoralis major myo-cutaneous (PMMC) flap continues to be a widely used tool to reconstruct oral cavity defects. But an unreliable and unstable vascular supply can lead to complications like flap loss, Oro-cutaneous fistula and wound dehiscence. Preservation of the lateral thoracic artery (LTA) has been suggested to improve the vascularity of the skin paddle. The present study aspires to compare the complications and flap related outcomes after preserving or sacrificing the LTA while reconstructing oral cavity defects with bi-folded PMMC flap. Materials and Methods: Retrospective analysis of the data of 61 male patients who were reconstructed with bi-folded PMMC flaps between January 2022 and September 2022 was done. 36 patients were reconstructed using a PMMC flap where the LTA was sacrificed, whereas in 25 patients the LTA was preserved. Data was analyzed in terms of patient factors and flap related complications. Results: The overall complication rate including major/minor complications was 44.26% with flap detachment at 22.95% being the commonest complication observed. 13.11% patients developed an Oro-cutaneous fistula and partial and complete flap loss were seen in 9.83% and 4.91% respectively. LTA preservation was significantly associated with only decreased flap detachment rates (p value < 0.05). No significant association was noticed between other flap related complications and LTA preservation. Conclusion: Reconstructing larger defects with a PMMC flap where the LTA is preserved can help improve the vascularity of the flap and decrease various major/minor flap related complications.

Supplementary information: The online version contains supplementary material available at 10.1007/s12070-023-04123-3.

Keywords: Head and Neck cancers; Lateral thoracic artery; Oral cavity cancers; Oral cavity reconstruction; PMMC flap.

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