[Feasibility of a Heart-Shaped Modified Pectoralis Major Myocutaneous Flap for a Stabilized Vascular Supply in the Reconstruction of Surgically Induced Defects in Patients with Advanced Oral Cancer].

The pedicled pectoralis major myocutaneous(PMMC)flap, used for the reconstruction of surgical defects in advanced oral cancer resection, is versatile and can be obtained without a highly-invasive procedure. However, flap utility is limited by an unstable blood supply and the relatively high rate of partial necrosis of the skin island. Thus, the use of microvascularized free flaps has become more common in patients requiring oral-maxillofacial reconstruction. Detailed angiographic studies revealed the 3-dimensional vascular anatomy of the PMMC flap. This allowed us to obtain a modified, heart-shaped flap with a skin island that includes the intramuscular vascular networks between the pectoral branches of the thoracoacromial vessels and the intercostal perforators of the internal mammary vessels, thus ensuring a sufficient blood supply and stable survival of the flap. We have used this technique since 2015 to treat 7 patients with locally advanced or recurrent(salvage)oralcancer. None developed critical flap problems, and survival of the total skin island was successfully obtained in all cases. Transfer of the heart-shaped PMMC, including the multiple intercostal perforators from the internal mammary vessels, may contribute to a stable blood supply of the skin island and therefore can be effective for advanced oral cancer reconstruction.