Pectoralis Major Myocutaneus Flap Failure in Cheek Reconstruction: A Case Report with Review of Controversial Considerations

Abstract

Background: Pectoralis Major Myocutaneous Flap (PMMCF) is a commonly used approach in reconstructive surgery for defects in the head and neck region, especially for closing cheek defects. Although flap failure is uncommon, it significantly impacts patient morbidity and diminishes quality of life, making investigation into its causes important.

Methods: A case of pectoralis major myocutaneous flap failure following cheek reconstruction is presented. A focused literature review was conducted through PubMed, Scopus, and ScienceDirect to identify studies reporting PMMCF complications, proposed etiologic mechanisms, and management considerations in head and neck reconstruction.

Results: The literature review identified multiple studies reporting pectoralis major myocutaneous flap complications in head and neck reconstruction, most commonly venous congestion and partial flap necrosis. Reported failure mechanisms were heterogeneous, with pedicle compression, tunneling-related tension, infection, and patient-related factors emerging as recurrent themes.

Conclusion: PMMCF has a multifactorial etiology. Close postoperative monitoring is essential to detect early complications and optimize outcomes. PMMCF is insufficient for stage 3 defects, worsened by poor vascularization and oxygenation.

Keywords: Pectoralis Major Myocutaneous Flap failure; Oral cancer reconstruction; Squamous cell carcinoma, Adjuvant therapy