Evaluating the Success of Pectoralis Major Myocutaneous Flap in Mandibular Reconstructions in Relation to Defect Localization

Timarcioglu G., Sen O., Gedik E., Bahran U., Karacakurtoglu M., Candirli C.

Journal of Maxillofacial and Oral Surgery, 2024 (ESCI) identifier

  • Publication Type: Article / Article
  • Publication Date: 2024
  • Doi Number: 10.1007/s12663-024-02126-3
  • Journal Name: Journal of Maxillofacial and Oral Surgery
  • Journal Indexes: Emerging Sources Citation Index (ESCI), Scopus
  • Keywords: Mandibular reconstruction, Myocutaneous flap, Pectoralis major, Postoperative complications
  • Istanbul Medipol University Affiliated: Yes


Objectives: In this study, the success of mandibular reconstructions with pectoralis major myocutaneous flaps (PMMF) was assessed based on the location of the defect. Materials and Methods: The data obtained from patients who had previously undergone PMMF reconstruction during a 3-year period, from 2018 to 2021, was retrospectively analyzed using predetermined criteria (postoperative complications, flap survival). Cases included were treated using Urkens’ technique at the Istanbul Sultan 2. Abdulhamid Han Training and Research Hospital of the University of Health Sciences, defects were classified according to Browns’ classification. Results: 18 individuals, ages ranging from 28 to 82 (M: 59.05) with differing diagnoses (squamous cell carcinoma [SCC] [n = 11], myoepithelial carcinoma [MEC] [n = 1], osteosarcoma [n = 3], medication-related osteonecrosis [MRONJ] [n = 2], gunshot wound [n = 2]) were chosen for the analysis. Based on Browns’ classification, 8 defects were noted to be Class I, while the remaining 4 and 6 were classified as class II and class III, respectively. Postoperative complications in class III cases included partial necrosis (n = 4), orocutaneous fistula (n = 3), wound dehiscence (n = 2) and plate exposure (n = 3). No major postoperative complications occurred in class I and majority of the class II defects. Class I cases had a 100% success rate (n = 8), while the reconstruction of class III defects had a significantly lower success rate, with only 1 of the 6 cases considered successful. Compared to Class III, the class II cases had a relatively high success rate (75%, n = 3), one of the cases being considered unsuccessful. Conclusion: In comparison with class I and II, Class III defects involving the anterior mandible were found to have a higher rate of complications. This difference in clinical outcome is thought to be associated with decreased flap vascularity stemming from the arc of rotation. Utilizing free flaps will provide a better clinical outcome in aforementioned defects; thus, in Class III defects, PMMF should be preferred when free flaps are contraindicated or as a salvage flap.