The pectoralis major myocutaneous pedicled flap-Its past and current practice in a dedicated microsurgery service. Review of the literature, and debunking controversies.

Autor: Dimovska EOF; Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan; Department of Surgical Sciences, Uppsala University, Uppsala Sweden., Deek NA; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan; Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan; Cleveland Medical Center, University Hospitals and Case Western Reserve School of Medicine, Cleveland, OH, USA., Wei FC; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan; Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan. Electronic address: fuchanwei@gmail.com.
Jazyk: angličtina
Zdroj: Journal of plastic, reconstructive & aesthetic surgery : JPRAS [J Plast Reconstr Aesthet Surg] 2024 Nov 28; Vol. 101, pp. 150-160. Date of Electronic Publication: 2024 Nov 28.
DOI: 10.1016/j.bjps.2024.11.047
Abstrakt: Background: The pectoralis major myocutaneous pedicled (PMMP) flap is still considered by many a workhorse flap in head and neck (H&N) reconstruction, despite free flap surgery advancing. The authors aimed to examine this claim and associated myths and controversies by analyzing literature trends and revealing the role of the PMMP flap in a well-established microsurgery center.
Methods: The senior author's reconstructive H&N practice between 1995 and 2022 was reviewed to describe and critically judge primary and secondary PMMP flap decisions to provide invaluable lessons learned and debunk common controversies related to complex H&N reconstruction. A literature review from 1978 to 2022 evaluated PMMP flap articles from plastic surgery and allied H&N specialties, with a deeper analysis on publications from 2010 onward.
Results: In 27 years of practice, the senior author performed 2871 major H&N reconstructions, including 27 PMMP flaps. Both primary (13/27) and secondary (14/27) PMMP flaps decreased over time. Indications shifted from external skin compromise (fistulae/metastases) to complex medical morbidity and high-risk neck status. Neck status was increasingly evaluated based on any previous violation, surgical or irradiative, rather than simply number of remaining vessels. A literature review revealed an ongoingly abundant and primary PMMP flap use, largely by non-plastic surgeons.
Conclusion: The PMMP flap can and should be reserved for complex, high-risk or free flap-exhausted cases. Thus, current indications deserve redefinition. Multidisciplinary collaboration in specialized centers with plastic surgeons is imperative to ensure appropriate reconstructive rational and protect patient outcomes, as changing reconstructive hands and starting anew risks reconstructive regression.
(Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. All rights reserved.)
Databáze: MEDLINE
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