Evaluation of flap complications following pectoralis major myocutaneous flap reconstruction for oral cancers

Oral cavity cancer is among the leading cause of cancer death in India. Pectoralis major myocutaneous flaps (PMMC) are still widely used for the reconstruction of defects pertaining to head and neck region, though free flaps are considered to be gold standard. The study was aimed to identify the risk factors involved in post - operative complications of PMMC Flap for oral subsites. A total of 266 patients operated in an oncology institute over 2 years of time was evaluated based on their demographic data, pre and post-surgery details, post-operative flap morbidity were collected retrospectively from master case sheets from January 2022 to January 2024. Factors such as age, gender, stage of disease, diabetic status, and hypoprotenemia and radiation therapy were seen, analysed to find their relation in causing flap complications. Totally 266 patients were included for analysis and 16.9 % had major flap complications. On detailed analysis, it was seen that larger bipaddled flaps had higher flap complication rate, highest being wound infection. PMMC Flap is a viable option for head and neck cancer reconstruction, specifically in cases where free microvascular flaps are not done routinely and patient presents with multiple comorbidities. Careful patient selection, pre – operative optimization, operating surgeon experience and post-operative care are contributing factors to reduce flap complications. • PMMC flap along with its modifications is the most cost-effective and reliable method of reconstruction in head and neck surgery. • PMMC flap has many advantages namely versatility, local availability, ease of harvesting, excellent blood supply with reliable pedicle. • The highest complication rate of 6 % was noted as wound infection. Surgeon's experience is paramount and critical with complication rate of the PMMC flap. • Two utmost important factors of the flaps are functional results and morbidity. Incorporation of enough perforators in the skin pedicle should be given special attention.