Versatile, Bi-paddle Pectoralis Major Myocutaneous Flap in a High Risk Geriatric Male with Multiple Co-Morbidities, Presented with Advanced, Complex Oro-mandibular Cancer: A Case Report

Abstract

The study reporting a case of a 78 year old elderly male patient with multiple co-morbidities  with poor performance status with advanced oro-mandibular cancer who underwent oncological resection followed by reconstruction with bi-paddle PMMC flap as an alternative to micro-vascular free flap. Composite resection of the advanced or-mandibular cancer results in extensive defects which poses a challenge to the treating team as it will be difficult to restore mastication, speech and swallowing function. In head and neck cancers, free flaps have been used increasingly to cover the defect with the help of experienced and trained surgeons with fine skills of micro-vascular procedures. However , free flaps are not easily available at all centers in developing countries because of resource constraint, cost and expertise of surgeon. PMMC flap is the robust flap and it has been described and established since long in covering the both, intra and extra oral defects . With the help of random flap and multiple perforators, PMMC flap can mould into bi-lobed / bi-paddle / folded version which can cover intra-oral defect with covering of external lining. Bi-paddle PMMC flap is highly vascularized, versatile flap with short and easy learning curve and produces satisfactory aesthetic and functional results and should be considered as a first option in a geriatric patient with multiple co-morbidities.