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<p>Oral cancer often presents in advanced stages, requiring complex surgical interventions. The bipaddle pectoralis major myocutaneous (PMMC) flap is a commonly used alternative to the gold standard free flaps for reconstruction in resource-constrained settings. However, large defects often require a dual flap for closure. This study explores the use the Cervicothoracic flap as a potential second flap in addition to the PMMC flap for advanced oral cancer reconstruction. A retrospective analysis was conducted on patients with advanced oral cancer with extensive cheek skin involvement. Cervicothoracic flap was used in addition to the PMMC flap for the reconstruction of complex oral cavity defects. Patient demographics, clinical features, treatment stage, operative details, and postoperative complications were meticulously recorded. The study reviewed 188 patients with advanced oral cavity cancer. Among them, 12 consecutive patients (11 males and 1 female; median age 49 years) underwent dual pedicled reconstruction using a cervicothoracic flap with a PMMC flap. Neoadjuvant chemotherapy was administered to six patients. Postoperative complications included two cases of superficial surgical site infection, one marginal flap necrosis, and two delayed fistulas. One patient died due to a postoperative myocardial infarction. In resource-constrained settings, a dual pedicled approach using PMMC for intraoral lining with a cervicothoracic flap for external coverage appears to be a feasible option to achieve tension-free closure and acceptable early outcomes in selected, advanced oral cavity defects.</p>

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Cervico-Thoracic Flap- A Potential Flap for Closure of Complex Oral Cavity Defect Closure: An Innovative Approach in Resource-Constrained setting

  • 期刊论文

  • 发表日期：

    2026年3月10日

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  • Pallvi Kaul,
  • Kanika Kapur,
  • Ajeet Ramamani Tiwari,
  • Pankaj Kumar Garg

摘要

Oral cancer often presents in advanced stages, requiring complex surgical interventions. The bipaddle pectoralis major myocutaneous (PMMC) flap is a commonly used alternative to the gold standard free flaps for reconstruction in resource-constrained settings. However, large defects often require a dual flap for closure. This study explores the use the Cervicothoracic flap as a potential second flap in addition to the PMMC flap for advanced oral cancer reconstruction. A retrospective analysis was conducted on patients with advanced oral cancer with extensive cheek skin involvement. Cervicothoracic flap was used in addition to the PMMC flap for the reconstruction of complex oral cavity defects. Patient demographics, clinical features, treatment stage, operative details, and postoperative complications were meticulously recorded. The study reviewed 188 patients with advanced oral cavity cancer. Among them, 12 consecutive patients (11 males and 1 female; median age 49 years) underwent dual pedicled reconstruction using a cervicothoracic flap with a PMMC flap. Neoadjuvant chemotherapy was administered to six patients. Postoperative complications included two cases of superficial surgical site infection, one marginal flap necrosis, and two delayed fistulas. One patient died due to a postoperative myocardial infarction. In resource-constrained settings, a dual pedicled approach using PMMC for intraoral lining with a cervicothoracic flap for external coverage appears to be a feasible option to achieve tension-free closure and acceptable early outcomes in selected, advanced oral cavity defects.