A Conventional Approach to Repair Irreparable Head and Neck Defects with Non-Microsurgical Techniques: The Role of Anterior Chest Wall

Abstract

Objective: This study aimed to evaluate the role of anterior chest wall pedicled flaps in patients with complex head and neck defects who were unsuitable for microsurgical reconstruction due to advanced age, comorbidities, or prior radiotherapy.

Materials and Methods: A retrospective evaluation was conducted on seven patients who underwent anterior chest wall pedicled flap reconstruction between 2019 and 2024. The selection of flaps, such as deltopectoral, cervicopectoral, and pectoralis major myocutaneous flaps, was determined by the patient's risk profile and defect features. Analysis was done on demographic information, hospital stays, length of stay in the intensive care unit (ICU), and problems following surgery.

Results: The mean age was 68 years. Deep neck infection, radiation-related problems, and oncologic resection were among the indications. Three deltopectoral, one cervicopectoral, and three pectoralis major flaps were used. There was no complete flap loss. Conservative management was used for minor problems. The mean ICU stay was three days, and the mean hospital stay was 13 days.

Conclusion: Anterior chest wall pedicled flaps remain reliable alternatives for complex head and neck reconstruction in high-risk patients, offering stable coverage with acceptable complication rates.

Keywords

• head and neck reconstruction
• pedicled flap
• pectoralis major myocutaneous flap
• deltopectoral flap
• cervicopectoral flap
• comorbidity

Project Number

None

References

1. Galbiatti AL, Padovani-Junior JA, Maníglia JV, Rodrigues CD, Pavarino ÉC, Goloni-Bertollo EM. Head and neck cancer: causes, prevention and treatment. Braz J Otorhinolaryngol 2013;79(2):239-247. google scholar
2. Chow LQM. Head and Neck Cancer. N Engl J Med 2020;382(1):60-72. google scholar
3. Forner D, Williams BA, Makki FM, Trites JR, Taylor SM, Hart RD. Late free flap failure in head and neck reconstruction: a systematic review. Ear Nose Throat J 2018;97(7):213-216. google scholar
4. Correia C, Wang W, Vincent AG, Chan D, Ducic Y. Regional salvage flap options in head and neck reconstruction. Semin Plast Surg 2020;34(4):293-98. google scholar
5. Bhanja A, D’Souza DS, Roy C, Poddar RN. Reliability of the pectoralis major myocutaneous flap in reconstructive oral cancer surgery in developing countries: Our experience. Med J Armed Forces India 2016;72(Suppl 1):S1-7. google scholar
6. Portnoy WM, Arena S. Deltopectoral island flap. Otolaryngol Head Neck Surg 1994;111(1):63-9. google scholar Kruse AL, Luebbers HT, Obwegeser JA, Bredell M, Grätz KW. Evaluation of the pectoralis major flap for reconstructive head and neck surgery. Head Neck Oncol 2011;3:12. google scholar
7. Pecorari G, Bissattini F, Gamba D, Pizzo C, Motatto GM, Riva G. Deltopectoral flap in head and neck reconstruction. Medicina (Kaunas) 2024;60(10):1615. google scholar
8. Teo KG, Rozen WM, Acosta R. The pectoralis major myocutaneous flap. J Reconstr Microsurg 2013;29(7):449-56. google scholar

9. Soler-Presas F, Cuesta-Gil M, Borja-Morant A, Concejo-Cútoli C, Acero-Sanz J, Navarro-Vila C. Midface soft tissue reconstruction with the facio-cervico-pectoral flap. J Craniomaxillofac Surg 1997;25(1):39-45. google scholar
10. Yang X, Ren H, Guo X, Hu C, Fu J. Radiation-induced skin injury: pathogenesis, treatment, and management. Aging (Albany NY) 2020;12(22):23379-93. google scholar
11. Haubner F, Ohmann E, Pohl F, Strutz J, Gassner HG. Wound healing after radiation therapy: review of the literature. Radiat Oncol 2012;7:162. google scholar
12. Onoda S, Kimata Y, Sugiyama N, Onoda T, Mizukawa N. Effects of radiation therapy on postoperative complications and adverse events in patients with head and neck reconstruction with flaps. Microsurgery 2014;34(7):516-21. google scholar