Assessment of Clinical and Histological Changes in the Skin Paddle of Pectoralis Major Myocutaneous Flap in Intraoral Reconstruction: A Prospective Cohort Study. Issue 2 (February 2020)

• Record Type: Journal Article
• Authors: Behera, Saswati; Mohsina, Subair; Tripathy, Satyaswarup; John, Jerry R.; Sharma, Ramesh Kumar; Panda, Naresh Kumar; Bakshi, Jaimanti; Radotra, Bishan Dass; Sahu, Ranjit Kumar
• Is Part Of: Annals of plastic surgery. Volume 84:Issue 2(2020)
• Publication Date: 2020-02
• Subjects: PMMC flap -- metaplasia -- mucosalization -- horny layer -- gross morphology -- cutaneous -- appendages -- skin architecture; Surgery, Plastic -- Periodicals; 617.95205
• DOI: 10.1097/SAP.0000000000002024
• Languages: English
• ISSNs: 0148-7043

Abstract

Abstract : Purpose: This study was carried out to characterize the clinical and histological changes in the cutaneous portion of the transferred pedicled pectoralis major myocutaneous flaps used in intraoral reconstruction in patients with head and neck malignancy. Methods: This was a prospective cohort study carried out from July 2016 to 2018. All patients underwent ablative surgery for oropharyngeal cancers and primary reconstruction with pedicled pedicled pectoralis major myocutaneous flaps. The intraoral flaps were examined for color, texture, presence of hair, chronic inflammatory changes, and ulceration. At 12 months, incisional biopsies were taken from the skin paddle of the intraoral flap and contralateral normal buccal mucosa, and flap histology was compared with that of the contralateral buccal mucosa. Results: Twenty patients were included in the final analysis (M/F, 4:1; mean ± SD age, 51.38 ± 6.76 years). Fourteen flaps resembled oral mucosa, 3 had a mixed appearance of both skin and mucosa, and 3 had appearance of normal skin at 1 year follow-up. The epidermis and stratum corneum were retained in all the flap biopsies; however, severe attenuation was noted in 7 patients (had mucosal appearance) but was significantly different from oral mucosa( P = 0.0003). Cutaneous appendages were found in all the flap epithelia. Thirteen flaps showed grossly attenuation, of which 11 patients had a gross appearance resembling oral mucosa and 2 had a mixed appearance. The biopsies showed varied degree of chronic changes like desquamation in around 35% (7 patients), hyperkeratosis in 35% (7 patients), and chronic candidiasis in 30% (6 patients). Conclusions: Although the intraorally transferred flaps demonstrate a morphological appearance similar to oral mucosa, there is a histological preservation of skin elements and architecture.