Reliability of Pectoralis Major Myocutaneous Flap Reconstruction in Patients with Oral Cavity Squamous Cell Carcinoma in the Era of Free Flap Reconstruction: Our Experience and Review of Literature

ABSTRACT Background: The incidence of oral cavity cancers is rising globally. Surgical excision forms the mainstay of treatment of these lesions. The locally advanced stage of presentation makes the excision and reconstruction extremely challenging. The current gold standard for reconstruction is microvascular free flap reconstruction. Pectoralis major myocutaneous (PMMC) flap still remains a viable option due to its anatomical advantages including ease of harvest and lower technical demands. This study highlights the technique, reliability, and outcomes of PMMC flap reconstruction. Materials and Methods: A retrospective study was done including 70 patients with oral squamous cell carcinoma who underwent surgical resection (wide local excision and neck dissection) followed by reconstruction using PMMC flap through submammary approach. Results: The majority of patients were males (47), with a mean age of 48 years. The most common site of carcinoma was buccal mucosa (41). Intraoral wound dehiscence of the flap occurred in 10% of cases healing naturally. Complete necrosis was seen in 3 cases (4.28%) of which only one case required salvage flap reconstruction. Minor complications included axillary seroma which was seen in 5.7% of patients. Conclusion: PMMC flap continues to be a viable option for reconstruction in oral cancers even in the era of free flap repair. It can be still reliably be used as a method of reconstruction particularly in developing countries like India, where financial limitations and a lack of specialized medical infrastructure make more complex techniques less feasible.