Lateral Thoracic Artery Can Stabilize Circulation in the Pectoralis Major Myocutaneous Pedicle Flap: Single-center, Prospective, Uncontrolled Case Series
Background:. Head and neck reconstructions using the pectoralis major myocutaneous pedicle flap (PMMF) with thoracoacromial artery alone are prone to hemodynamic instability, possibly leading to infection, prolapse, hematoma, seroma, and partial or total flap failure (6%–71%). Aside from unstable bl...
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Wolters Kluwer
2021
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oai:doaj.org-article:23ff39fcd1d849f8a8fc08388d0125b02021-11-25T07:57:34ZLateral Thoracic Artery Can Stabilize Circulation in the Pectoralis Major Myocutaneous Pedicle Flap: Single-center, Prospective, Uncontrolled Case Series2169-757410.1097/GOX.0000000000003860https://doaj.org/article/23ff39fcd1d849f8a8fc08388d0125b02021-10-01T00:00:00Zhttp://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003860https://doaj.org/toc/2169-7574Background:. Head and neck reconstructions using the pectoralis major myocutaneous pedicle flap (PMMF) with thoracoacromial artery alone are prone to hemodynamic instability, possibly leading to infection, prolapse, hematoma, seroma, and partial or total flap failure (6%–71%). Aside from unstable blood circulation, reported risk factors for these complications include feminine gender, smoking, and having diabetes mellitus. Preservation of the lateral thoracic artery in addition to the thoracoacromial artery has been suggested as a way to improve unstable blood circulation in the PMMF. Methods:. This is a single-center, prospective, uncontrolled case series. Circulation to the PMMF was studied intraoperatively with and without lateral thoracic artery clamping after harvest. Indocyanine green (ICG) angiopathy, a quantitative hemodynamic assessment method, was used to analyze three parameters: maximum intensity (Imax), time from start of ICG to maximum intensity (Tmax), and slope of intensity (Smax = Imax/Tmax). Hemodynamic parameters, such as pulse rate and blood pressure, were all within normal ranges. Allergy to contrast media was criterion for exclusion. Results:. Six patients all had oral cancer as their primary disease. Their background was characterized by established risk factors: four patients had a history of smoking, two had diabetes mellitus, and two were women. Postoperatively, no patients had complications at the recipient or donor sites. Mean results of the analysis were Imax: 60 ± 47, Tmax: 91 ± 55, Smax: 0.8 ± 0.5 in the clamped group and Imax: 85 ± 40, Tmax: 73 ± 42, Smax: 1.8 ± 1.5 in the un-clamped group. Significant difference was observed in Imax (P = 0.03) and Smax (P = 0.03). Conclusion:. Lateral thoracic artery preservation appears to be useful for stabilizing blood circulation to the PMMF, including in patients considered to be at high-risk for complications, such as women, smokers, and patients with diabetes mellitus.Shinji Kumegawa, MDHidetaka Miyazaki, DDS, PhDYasuhiro Sakata, MDKazuhisa Uemura, MDKazuki Ueno, MDYoshitaka Wada, MD, PhDTaiju Hyuga, MD, PhDShinichi Asamura, MD, PhDWolters KluwerarticleSurgeryRD1-811ENPlastic and Reconstructive Surgery, Global Open, Vol 9, Iss 10, p e3860 (2021) |
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Surgery RD1-811 |
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Surgery RD1-811 Shinji Kumegawa, MD Hidetaka Miyazaki, DDS, PhD Yasuhiro Sakata, MD Kazuhisa Uemura, MD Kazuki Ueno, MD Yoshitaka Wada, MD, PhD Taiju Hyuga, MD, PhD Shinichi Asamura, MD, PhD Lateral Thoracic Artery Can Stabilize Circulation in the Pectoralis Major Myocutaneous Pedicle Flap: Single-center, Prospective, Uncontrolled Case Series |
| description |
Background:. Head and neck reconstructions using the pectoralis major myocutaneous pedicle flap (PMMF) with thoracoacromial artery alone are prone to hemodynamic instability, possibly leading to infection, prolapse, hematoma, seroma, and partial or total flap failure (6%–71%). Aside from unstable blood circulation, reported risk factors for these complications include feminine gender, smoking, and having diabetes mellitus. Preservation of the lateral thoracic artery in addition to the thoracoacromial artery has been suggested as a way to improve unstable blood circulation in the PMMF.
Methods:. This is a single-center, prospective, uncontrolled case series. Circulation to the PMMF was studied intraoperatively with and without lateral thoracic artery clamping after harvest. Indocyanine green (ICG) angiopathy, a quantitative hemodynamic assessment method, was used to analyze three parameters: maximum intensity (Imax), time from start of ICG to maximum intensity (Tmax), and slope of intensity (Smax = Imax/Tmax). Hemodynamic parameters, such as pulse rate and blood pressure, were all within normal ranges. Allergy to contrast media was criterion for exclusion.
Results:. Six patients all had oral cancer as their primary disease. Their background was characterized by established risk factors: four patients had a history of smoking, two had diabetes mellitus, and two were women. Postoperatively, no patients had complications at the recipient or donor sites. Mean results of the analysis were Imax: 60 ± 47, Tmax: 91 ± 55, Smax: 0.8 ± 0.5 in the clamped group and Imax: 85 ± 40, Tmax: 73 ± 42, Smax: 1.8 ± 1.5 in the un-clamped group. Significant difference was observed in Imax (P = 0.03) and Smax (P = 0.03).
Conclusion:. Lateral thoracic artery preservation appears to be useful for stabilizing blood circulation to the PMMF, including in patients considered to be at high-risk for complications, such as women, smokers, and patients with diabetes mellitus. |
| format |
article |
| author |
Shinji Kumegawa, MD Hidetaka Miyazaki, DDS, PhD Yasuhiro Sakata, MD Kazuhisa Uemura, MD Kazuki Ueno, MD Yoshitaka Wada, MD, PhD Taiju Hyuga, MD, PhD Shinichi Asamura, MD, PhD |
| author_facet |
Shinji Kumegawa, MD Hidetaka Miyazaki, DDS, PhD Yasuhiro Sakata, MD Kazuhisa Uemura, MD Kazuki Ueno, MD Yoshitaka Wada, MD, PhD Taiju Hyuga, MD, PhD Shinichi Asamura, MD, PhD |
| author_sort |
Shinji Kumegawa, MD |
| title |
Lateral Thoracic Artery Can Stabilize Circulation in the Pectoralis Major Myocutaneous Pedicle Flap: Single-center, Prospective, Uncontrolled Case Series |
| title_short |
Lateral Thoracic Artery Can Stabilize Circulation in the Pectoralis Major Myocutaneous Pedicle Flap: Single-center, Prospective, Uncontrolled Case Series |
| title_full |
Lateral Thoracic Artery Can Stabilize Circulation in the Pectoralis Major Myocutaneous Pedicle Flap: Single-center, Prospective, Uncontrolled Case Series |
| title_fullStr |
Lateral Thoracic Artery Can Stabilize Circulation in the Pectoralis Major Myocutaneous Pedicle Flap: Single-center, Prospective, Uncontrolled Case Series |
| title_full_unstemmed |
Lateral Thoracic Artery Can Stabilize Circulation in the Pectoralis Major Myocutaneous Pedicle Flap: Single-center, Prospective, Uncontrolled Case Series |
| title_sort |
lateral thoracic artery can stabilize circulation in the pectoralis major myocutaneous pedicle flap: single-center, prospective, uncontrolled case series |
| publisher |
Wolters Kluwer |
| publishDate |
2021 |
| url |
https://doaj.org/article/23ff39fcd1d849f8a8fc08388d0125b0 |
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