Combined use of pectoralis major myocutaneous and free radial forearm flaps for reconstruction of through-and-through defects from excision of head and neck cancers

Objectives: The aim of this study was to examine the outcome and complication in patients who underwent reconstruction with combined use of pectoralis major myocutaneous flap (PMMCF) and free radial forearm flap (FRFF) for the through-and-through defect after surgical resection for head and neck cancer. Method: Twelve patients underwent primary reconstruction with the combined use of PMMCF and FRFF for through-and-through defect of facial or cervical skin and oral or pharyngeal mucosa resulting from treatment of head and neck cancer. Free radial forearm flap was used for three patients with oral mucosal defect, two patients with oropharyngeal mucosal defect, and two patients with defect from total laryngopharyngectomy. The osteocutaneous FRFF was used for five patients with defect of oral mucosa and mandible. Pectoralis major myocutaneous flap was used for seven patients with facial skin defect and five patients with cervical skin defect. Results: All PMMCFs and FRFFs were successful. Early complications were minor and occurred in 4 (33%) of 12 patients. No delayed complication was observed. During the follow-up period, 5 patients died of disease between 10 and 52 months. Currently, 6 patients are alive with no evidence of disease and 1 patient developed a distant metastasis to the lung. The follow-up period ranged from 12 to 54 months. Conclusion: For patients with through-and- through defect after resection of mucosa of upper aerodigestive tract and skin, the combination of PMMF and FRFF reconstruction achieved optimal long- term results.