Oral, Mouth and Throat Cancer

Biography

Biography: Jeetendar Paryani,

Abstract

PMMC with single stage DeltoPectoral (DP) Composite Flap in huge defects after head and neck surgery:- A innovative solution .

Introduction:- Carcinomas of Oral cavity are the most common malignancy in our country. Its not very uncommon for cancer to present at advanced stage. Resection of such lesion may result in large complex defects. Reconstruction of such defects could be done by loco Regional Flaps or combination of flaps or alone by free flaps. We describe the technique of composite PMMC –DeltoPectoral(DP) Flap reconstruction for reconstruction of such defects . This is a single stage procedure. Also the technique of DP has been modified so as to avoid detachment of flap later on so as minimize in hospital patient stay Methods: The patients with locally advanced oral cavity cancer from the period of September 2015 to December 2015 were operated & reconstructed using this technique in our institute. Standard Techniques used for resection & neck dissection. DP flaps were raised first with the usual technique after which PMMC flaps were raised.PMMC Flaps were used for coverage on the mucosal side of the defect and DP flap was used to cover the skin loss and both flaps sutured to each other at the junction. Donor site was covered with spilt thickness graft taken form thigh. Postoperative outcome and final cosmesis was evaluated Results: 10 patients were reconstructed using this technique. 9 were males and one was female. 4 patients were with central arch mandible lesion with involvement of chin skin, 5 were RMT and alveolus skin lesions with involvement of cheek skin. One patient was parotid malignancy with skin involvement .Only one patients suffered major Flap necrosis.. But patient recovered and reconstructed using the same flap. Two patients developed minor orocutaneous fistula which recovered on conservative management. The cosmesis of the patients was good Discussion: Large complex defects involving both oral cavity and skin posses a unique reconstructive challenge . Although a single free flap or combinations of free flap may represent a better solution, in country like ours such facilities may not be always available .This technique represents an innovative solution in reconstruction oral cavity defects with large skin loss . This flaps provide inner PMMC in oral lesion & DP provides outer skin coverage. We believe such technique resection has not been described in previously in literature. There has been a case where oral cavity defect was covered with PMMC and skin involvement in neck was covered by DP flap. But to use both the flaps which are sutured at the junction represents a new answer to difficult question of reconstruction of large defects. Also that solution does not require complex micro vessel anastomosis or significant donor site morbidity. Other options for reconstruction for such defects are bipaddle PMMC or forehead flap .Bipaddle PMMC is cumbersome in patient with fatty chests or females. Whereas forehead flap are esthetically not suitable for large defects they may also require second stage for division of flap Deltopectoral flaps also require second stage surgery for delay / divison of flap. We have modified the technique of flap in such a way that edge of flap is sutured to neck dissection wound. This avoids the need for second stage for divison of defect. Resulting in shortening of traditionally long hospital stay required for standard deltopectoral flaps. With continuing use of such composite flaps we plan to refine better technique & modifications to improve outcomes and cosmesis in patients requiring large reconstructions.