A TECHNIQUE FOR PRESERVATION OF CHOKE VESSELS FOR EXPANDING THE LIMITS OF PECTORALIS MAJOR MYOCUTANEOUS FLAP FOR RECONSTRUCTION IN ADVANCED ORAL CANCER SURGERY (T4A WITH SKIN INVOLVEMENT)

Parijat Suryavanshi*, Gitika Nanda Singh and Vinod Jain

ABSTRACT

Pectoralis major myocutaneous flap was first described in 1970s by Ariyan.[1] It is one of the most sturdy and versatile flap for reconstruction of large defects following resection of large oral cancers. In developing countries like India, it is not uncommon to have oral cancer patients with large primary involving skin of face and resectable. Such cases present a challenge to the treating Surgical Oncologist and reconstructive surgeon as option of free flap reconstruction may not be always available. In several centers treating oral cancers, there may be a paucity of plastic and reconstructive surgeons. In high volume centers like King George’s Medical University where several oral cancer cases are operated every week, limited number of reconstructive surgeons doing free flap has made pectoralis major myocutaneous (PMMC) flap a workhorse for reconstruction of defect following oral cancer reconstruction.[2] There, however, is a limitation to the amount of skin supplied by PMMC flap in case of large defects necessitating reconstruction of both buccal mucosa and skin with a bipedal flap with a concern of flap necrosis when surgeon overshoots the territory of PMMC flap while raising large flaps. We hereby describe a technique to increase the size of PMMC flap using concept of choke vessels.

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