Quality of life and survival assessments of tissue defect salvage reconstruction with pectoralis major myocutaneous flap following oral-maxillofacial malignancy resection

doi:10.21203/rs.3.rs-3461901/v1

Download PDF

Research Article

Quality of life and survival assessments of tissue defect salvage reconstruction with pectoralis major myocutaneous flap following oral-maxillofacial malignancy resection

https://doi.org/10.21203/rs.3.rs-3461901/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Purpose: The purpose of this study was to investigate the quality of life and survival of pectoralis major myocutaneous flap (PMMF) in soft tissue defect after resection of oral and maxillofacial malignancies.

Materials and Methods: A retrospective analysis was performed on 56 patients who underwent oral and maxillofacial malignancy removal with tissue defect from 1^st January 2015 to 1^st January 2018. The Chinese version of the Functional Assessment of Cancer Therapy-Head & Neck scale and the Kaplan-Meier method were used to assess the quality of life and survival rate, respectively.

Results: The grafted PMMFs had a satisfactory survival condition in all 56 cases. Compared with the preoperative period, the questionnaire at 6 months postoperatively showed a remarkable improvement in patients’ physical well-being, social/family well-being, emotional well-being, functional well-being, additional head and neck concerns as well as total score (P < 0.05). Moreover, the 3-year and 5-year survival rates calculated by Kaplan-Meier method were 48.2% and 42.1%, respectively.

Conclusions: Within the restrictions of this study, PMMF is a promising method for

salvage reconstruction of tissue defects after oral-maxillofacial malignancy resection due to it’s constant anatomical structure, abundant tissue volume, high survival rate and effective improvement of patients’ quality of life.

Oral and maxillofacial malignancy

Pectoralis major myocutaneous flap

The pectoralis major myocutaneous flap (PMMF) has been extensively favored by experts in oral and maxillofacial surgery, prosthetics, and head and neck surgery since its inception in 1979. Besides, it is one of the primary flaps considered for the reconstruction of defective tissue after resection of malignant tumors in the oral and maxillofacial areas, pharynx, and head and neck ^1–3. According to nearly 30 years of flap reconstruction studies, the PMMF could be considered as the first choice of flap for salvage repair, especially for patients with advanced tumors and those necessitating secondary salvage surgery, as well as for patients with donor site vascular compromise caused by surgery or oncologic radiation therapy ^4–7. Herein, a retrospective analysis of clinical studies relevant to the utilization of PMMFs for the reconstruction of defective tissue after removal of oral and maxillofacial malignancy was carried out.

2.1 Clinical information

Our study complied with the Declaration of Helsinki and was approved by the Ethics Committee of the First Affiliated Hospital of Bengbu Medical College (no. [2021] 219). The questionnaire survey was conducted between 1st July 2015 and 31st January 2023.

A retrospective study was conducted on 56 patients with oral and maxillofacial malignancy in our department from 1st January 2015 to 1st January 2018, of whom 47 were male and 9 were female, with an age range from 34 to 72 years and a mean age of 58.4 years. All patients were reconstructed with oral and maxillofacial radical surgery and one-stage repair with PMMF, and satisfactory outcomes were achieved. The patient details were listed in Table 1. Tumor/node/metastasis (TNM) staging according to the American Joint Committee on Cancer (AJCC) (8th Edition, 2017) was not available on account of the complicated tumor tissue origin and the therapeutic history of the primary lesion ^8–10. However, based on references to this staging and other literature, the TNM staging in this article can be summarized as follows ^9,11: All lesions infiltrating adjacent structures and even masticatory muscles were classified as intermediate (T4a) and very advanced (T4b) tumors with tumor invasion intensity (TII) greater than 10 mm. All 56 cases were M0, of which 26 showed regional lymph node metastasis (N3b) with unilateral lymph node diameter > 3 cm and extra nodal extension (ENE) (+); 14 showed unilateral lymph node metastasis (N3a); 4 showed unilateral lymph node metastasis > 3 cm and < 6 cm (N2a) with ENE (-); 6 showed multiple lymph node metastasis (N2b) with maximum diameter between 3–6 cm with ENE (-) and 6 were N0.

Table 1

Information of 56 cases receiving PMMF repair.
Classification	Case	Treatment history			Histopathological type
Classification	Case	Postoperative relapse	Secondary repair	After CRT or others	Squamous carcinoma	Adenomatous carcinoma	Mesenchymal carcinoma
Tongue cancer	16	6	4	6	13	3	0
Parotid carcinoma	12	7	2	3	3	9	0
Mandibular malignancy	15	8	1	6	10	0	5
Palatal cancer	13	4	1	8	7	6	0
Total	56	25	8	23	33	18	5
*CRT: Chemoradiotherapy

2.2 Surgical technique

2.2.1 Primary lesion treatment

Among the 56 patients who underwent repair, 8 patients were subjected to secondary salvage reconstruction with PMMF for the failed first repair, while the others were treated with extensive lesion excision and corresponding radical neck lymphatic tissue dissection. For patients with tongue cancer, 2 cases underwent total tongue resection; 5 cases underwent subtotal tongue resection; 2 cases underwent posterior mandibular resection with unilateral mental foramen. For patients with mandibular malignancy, 5 underwent unilateral mandibular extension resection; 9 underwent posterior mandibular extension resection with affected mental foramen; 6 underwent radical resection of the lateral skull base of the affected mandibular branch and the wound of the resected tissue was a perforated buccal tissue defect. For patients with parotid carcinoma, 7 cases showed recurrence postoperatively and 3 cases after radiotherapy and chemotherapy. The skin of the posterior face and external ear showed varying degrees of tissue defect after radical treatment. Preservation of the common trunk and all branches of the facial nerve was achieved in only 4 patients, and preservation of the common and temporal trunks was achieved in 3 patients. Postoperative tissue defects included partial skin behind the face and external ear canal, the entire lobe tissue of the parotid gland, and portions of the masticatory muscles. In addition, the mandibular branch was also removed in 5 patients.

2.2.2 Preparation of PMMFs and cranial and maxillofacial reconstruction

The PMMF was well designed by color Doppler ultrasound observation of the thoracoacromial artery and pectoral branches. Specifically, the pectoral branches and their lowest entry point on the surface projection of the thorax or the line between the scapula and the xiphoid process were marked with methylene blue. A vertical line was then drawn from the midpoint of the clavicle, the intersection of which was the lowest entry point of the pectoral branch, and the vertical extension line was the longitudinal axis of the designed flap. The distance between the superior end of the supra-axial flap and the clavicle was equal to or slightly greater than that between the inferior edge of the defective area and the clavicle. The distance from the distal inferior margin to the clavicle was equal to or slightly greater than that from the superior margin of the defect to the clavicle. The design of the pectoralis major flap size was based on the size of the wound cavity and the defective mucosa, which was slightly larger than that of the desired flap.

After that, a flap excision was performed. The subcutaneous tissue surrounding the designed flap was incised into the plane of the pectoralis major, followed by a relaxing incision along the lateral edge of the pectoralis major. If the flap was too large, the incision was relaxed along the vertical line of the middle clavicle to expose the pectoralis major muscle to be removed. The medial, inferior and lateral edges of the flap were sharply separated, and the designed flap was released from the medial side down to the lateral side up. After bluntly detaching the clavicular portion of the pectoralis major from the pectoralis minor, the branching vessels within the pectoralis major and the lowest entry point between the two muscles were located. With direct vision, the pectoralis major was transected 1.5 cm above the lowest entry point, thereby creating a bottleneck shape on the upper edge of the flap muscle. Intraoperative care was taken to protect the intrathoracic and extrathoracic nerves, internal thoracic artery, as well as the anastomotic vascular network formed by the perforating vessels of intercostal artery with the distal ends of the pectoral branches in the flap ^5,12.

The pedicle was then prepared below and above the lowest entry point of the pectoralis branch ^12–14, where the former vessels traveled through the pectoralis major and was prepared at the time of flap dissection, and the pedicle wrapped around an amount of the pectoralis major tendon sleeve ^15–17, while the latter vessels ran through the fascia between the pectoralis major and pectoralis minor, and the pedicle of this segment was prepared so as to carry a portion of the surrounding fascial tissue and the pedicle was able to free the flap upward by interrupting the clavicular portion of the pectoralis major on the surface or by tunneling through the clavicular portion of the pectoralis major.

Lastly, the craniomaxillofacial reconstruction was performed. In all 56 patients, the flap and pedicle were transferred to the head and neck through a subclavian tunnel. 37 of them had an intact clavicle, and the flap was gradually transferred to the neck through the subclavian tunnel by traction and propulsion under the protection of the medial clavicle vessels; in the other 18 cases, the clavicle was severed using a saw, after which the flap was transferred to the neck and anchored to the clavicle. In addition, the detailed restorative modalities included 12 cases of craniomaxillofacial extra-oral coverage restoration (Fig. 1), 29 cases of intra-oral soft tissue restoration (Fig. 2), and 15 cases of intra- and extra-oral folded restoration (Fig. 3).

2.3 Postoperative treatment

Head braking and flap blood supply were observed 4 days postoperatively. The patient received a nasogastric tube feeding for 10 days. 18 patients with fracture refixation due to clavicle sawing were advised to limit the movement of the affected upper arm for one month. All 36 patients who were not treated with radiotherapy preoperatively received adjuvant radiotherapy between 1 month and 1.5 months after surgery.

2.4 Postoperative follow-up

All patients were followed up for 6 months postoperatively for the observation of recovery regarding facial appearance, voice, swallowing and mouth opening. They were also followed up for 5 years to evaluate their survival and to calculate survival rates at 3 and 5 years using the Kaplan-Meier method, respectively.

2.5 Functional assessment of oncology treatment

The Chinese version of the Functional Assessment of Cancer Therapy-Head &Neck (FACT-H&N) scale was applied to investigate the quality of life (QOL) of patients prior to and after surgery (Table 2) ¹⁰.

Table 2

Scoring for the FACT-H&N
Domain	Number of entries	Scoring range	Scoring method
Physical well-being (PWB)	7	0 ~ 28	GP1 + GP2 + GP3 + GP4 + GP5 + GP6 + GP7
Social/Family well-being (SWB)	7	0 ~ 28	GS1 + GS2 + GS3 + GS4 + GS5 + GS6 + GS7
Emotional well-being (EWB)	6	0 ~ 24	GE1 + GE2 + GE3 + GE4 + GE5 + GE6
Functional well-being (FWB)	7	0 ~ 28	GF1 + GF2 + GF3 + GF4 + GF5 + GF6 + GF7
Functional Assessment of Cancer Therapy-General (FACT-G)	27	0 ~ 108	PWB + SWB + EWB + FWB
Additional concerns (FACT-HN)	9 + 2	0 ~ 36	hn1 + hn2 + hn3 + hn4 + hn5 + hn6 + hn7 + hn10 + hn11
Total		0 ~ 144	PWB + SWB + EWB + FWB + HNS
*PWB: Physical well-being; SWB: Social/Family well-being; EWB: Emotional well-being; FWB: Functional well-being; FACT-G: Functional Assessment of Cancer Therapy-General

2.6 Statistical analyses

A total of 56 questionnaires were distributed at preoperative, 3 months and 6 months postoperative, respectively, and 48 questionnaires were collected, all of which were eligible. For all statistical comparisons, IBM SPSS software (version 24) was employed for analysis, and results were shown as mean ± standard deviation, and one-way analysis of variance (ANOVA) and Tukey post-hoc test were used to evaluate the statistical significance, with P < 0.05 being the statistical difference.

3.1 Craniomaxillofacial reconstruction and patient recovery

The maximum area of PMMF was 18 cm ×16 cm and the minimum was 7 cm × 9 cm. The length of the PMMF ranged from 13 to 20 cm, with an average length of 15.5 cm. All flaps survived well, except for 3 cases with necrosis at the distal edge of the flap and 2 cases with flap crisis within 24 hours, which recovered well after treatment. The mean duration of hospitalization was 12.7 days with a range of 10–15 days. At the time of discharge, 3 cases had distal flap edge necrosis with incomplete healing of the reconstructed area, 4 cases had slight wound infection, and the rest had one-stage healing and donor site wounds were one-stage healed. Six months after surgery, the patient's mouth opening, vocalization and swallowing functions had returned to normal, and their facial appearance was basically satisfactory.

3.2 Postoperative survival rate

The cumulative survival rate was 48.2% at 3 years and 42.1% at 5 years postoperatively.

3.3 Pre - and postoperative QOL

The QOL preoperatively and at 3 and 6 months postoperatively were shown in Table 3. The lowest mean QOL questionnaire values at 3 months postoperatively were mainly due to patients’ fear of surgery and postoperative treatment, dissatisfaction with facial appearance and functional recovery, and concern about tumor recurrence; however, there was no statistical difference compared with the preoperative QOL (P > 0.05). In addition, the highest mean QOL was observed at 6 months postoperatively, which was statistically significant (P < 0.05) in comparison with both preoperative and 3 months postoperative. The dominant element affecting QOL was the side effects caused by postoperative adjuvant treatments such as radiotherapy and chemotherapy ^18,19.

Table 3

Comparison of scores at different time points before and after treatment
Domain	Scores at different time points			Comparison of P values at different time points
Domain	t1	t2	t3	t1 vs t2	t1 vs t3	t2 vs t3
PWB	18.51 ± 2.69	17.51 ± 4.82	23.11 ± 4.61	0.000	0.002	0.000
SWB	19.72 ± 6.11	20.81 ± 5.02	25.10 ± 4.42	0.120	0.001	0.120
EWB	16.63 ± 6.03	16.52 ± 4.29	20.62 ± 4.91	0.320	0.000	0.000
FWB	15.11 ± 4.98	13.77 ± 4.32	19.21 ± 3.11	0.070	0.000	0.000
FACT-G	68.18 ± 7.22	62.91 ± 5.22	87.38 ± 2.02	0.061	0.000	0.000
FACT-HN	26.65 ± 2.50	24.63 ± 3.21	30.24 ± 0.26	0.120	0.050	0.000
Total	102.73 ± 5.62	101.00 ± 10.22	121.00 ± 7.22	1.750	0.030	0.000

t1 preoperative; t2 postoperative after 3 months; t3 postoperative after 6 months

The application of PMMF has not only contributed to the advancement of head and neck oncologic surgery and craniomaxillofacial surgery for repair and reconstruction, but also improved the QOL and survival of patients with advanced head and neck carcinoma ^15–17,20. Therefore, the purpose of this study was to understand the anatomy and function of the flap and to rationally design a flap suitable for the pectoralis major donor and recipient area and the shape repair function.

In this regard, the following issues should be considered when designing flaps to repair tissue defects in the different areas mentioned above: 1) The design of the flap position is usually centered on the areola and divides the chest into four quadrants horizontally and vertically, namely the upper-inner quadrant, the upper-outer quadrant, the lower-inner quadrant and the lower-outer quadrant. Considering the shape of the chest and the length of the pedicle needed to repair maxillofacial defects, the ideal location of the flap should be in the lower and inner regions ²¹. The main nutritive vessels in this region are the rich capillary network formed by the intramuscular penetrating branches of the pectoralis major branch and the intercostal penetrating branches of the pectoral artery. It has also been reported that nutrition from the capillary network reaches the anterior sheath of the rectus abdominis muscle 3 cm-6 cm from the inferior border of the pectoralis major, which matches the capillary network of the superior abdominal artery ^12–14. Therefore, the PMMF is designed to comprise this area and carry part of the rectus abdominis muscle. Besides, the capillary network in this area should be perfectly protected when the flap is resected. The proximal end of the flap should be located not only on the medial aspect of the papilla but also on the lower line of the junction between the upper and lower quadrants. The distance from this point to the midpoint of the inferior margin of the clavicle should be slightly greater than that from the inferior margin of the maxillofacial defect area to the midpoint of the clavicle, and its shape is required to be comparable to that of the defective tissue ^22,23. Based on the above considerations, the characteristics of the tissue defect repair include: tissue excision for oral tongue floor defects mainly from the medial and inferior quadrants, mandibular buccal penetrating defects from the medial and lateral inferior regions, maxillary palatal defects from the inferior quadrant and anterior rectus abdominis sheath, and large craniomaxillofacial tissue defects from the medial inferior, lateral inferior, and anterior rectus abdominis sheath. 2) The surgical incision used is mainly along the surface protrusion of the pectoral muscle branches and around the flap or along the lateral edge of the pectoralis major and around the flap to cut the skin and subcutaneous tissue. In the former, the incision is entirely exposed accompanied by a visible chest scar, making it suitable for older, weaker patients or those with extensive flap removal, and the short operative time is preferred by men ^24,25. In the latter, the incision is inconspicuous and the flap is extracted through the thoracic tunnel. Therefore, it is most suitable for women under 60 years of age who are physically strong.

Although the scope of application of the pectoralis major has been gradually compressed with advances in microsurgery, it remains the first choice for oropharyngeal, craniomaxillofacial, head and neck flaps, especially in the following cases. Firstly, the modified PMMF is still the best choice for repairing tissue defects since microsurgical techniques are not guaranteed in developing countries and general tertiary hospitals in China. Secondly, advanced oral maxillofacial head and neck tumors have multiple tissue defects with damaged venous return vessels or suspected tumor cell infiltration at the donor site, therefore, pectoralis major repair can use sufficient tissue to reconstruct the defective structures while allowing complete resection of the tumor. Thirdly, for patients with tumor recurrence after radical tumor surgery and insignificant results of chemoradiotherapy, one is due to the absence or suspected injury of blood vessels in the donor area, and the other is due to the lymphatic tissue in the neck requiring radical surgery. Most of the neck tissue defects need to be filled and arteries need to be covered. Fourthly, it can be used as a salvage repair treatment for failed microsurgical stage I repairs. Lastly, PMMF could be the preferred option for older, weaker, or systemic patients who require a shorter operative time, and for patients who must undergo repair after tumor removal.

In addition, the experience with the modified PMMF in repair and reconstruction includes the following points. 1) It is ensured that the vascular pedicle is not twisted.2) Wound bleeding should be completely prevented. If necessary, iodoform gauze can be filled and withdrawn 3–4 days after surgery to avoid secondary bleeding. 3) The skin of the flap should be used primarily to reconstruct craniomaxillofacial defects, the pectoralis major to fill the remaining cavity, and the subcutaneous tissue to repair oral mucosal tissue defects. Complete myofascialization of the myofascial tissue occurs 15–20 days after repair of oral mucosal defects ²². 4) The vascular pedicle should ensure proper tightness. 5) Tissue defects at the donor site have the potential to detach from autologous sutures, and in only 1 of our 56 patients couldn't be completely autologously sutured, so a partial skin graft was used. All patients had no complications such as wound dehiscence and infection.

QOL, also known as health-related QOL, has been used as an independent evaluation index in many countries and regions recently. FACT-H&N is widely used as a QOL questionnaire after head and neck oncology treatment, and its reliability, validity, responsiveness and feasibility have been extensively confirmed ^23,24,26,27. By analyzing 48 questionnaires, the influential factors of QOL at each time point were as follows. 1) Factors influencing preoperative QOL. The first option was sudden illness leading to excessive mental stress, which accounted for 80% of the respondents. Secondly, the economic status of the family accounted for about 40%. Thirdly, pain caused by disease affecting speech and swallowing accounted for about 30%. 2) The most important factor affecting QOL at three months postoperatively was the persistent fear of surgery and postoperative treatment, which accounted for 90% of the questionnaires. Second, patients were dissatisfied with the recovery of sensation and function after treatment, accounting for approximately 50%. Third, about 10% of the patients were dissatisfied with the recovery of facial appearance. Thus, at this timepoint, the mean and additional values of the four functional conditions were not statistically significant in spite of being lower than before surgery (P > 0.05). 3) The main influencing factor of QOL at 6 months postoperatively was the side effects of postoperative adjuvant therapy, accounting for about 28%. Next, about 8% of patients were dissatisfied with the recovery of their facial shape and their function was affected. In addition, 3% of patients were concerned about tumor recurrence. At this time point, the patients' physical condition had largely recovered. Therefore, the mean value of QOL at this time point was remarkably higher than the above two time points (P < 0.05).

In short, by the analysis of these 56 cases and postoperative follow-up, the treatment of tissue defects after surgery for advanced oral and maxillofacial malignancy using PMMF can ensure the recovery of postoperative chest shape and function of the pectoralis major and improve the QOL and survival of patients.

The study was supported by the University Synergy Innovation Program of Anhui Province (GXXT-2020-021).

The authors declare that they have no conflict of interest of interest with respect to the research,authorship and publication of this article.

Conflict of Interest Disclosures: None of the authors have any relevant financial relationship(s) with a commercial interest.

Ethics statement/confirmation of patient’s permission: This study was approved by the Ethics committee of First Affiliated Hospital of Bengbu Medical College. Written consent for publication was obtained.

Funding: The study was supported by the University Synergy Innovation Program of Anhui Province (GXXT-2020-021).

Author Contribution：

Peijun Song (First Author): Writing - Original Draft, Methodology, Formal analysis.

Feng Zhuo (Co-First Author): Writing - Original Draft and Investigation .

Qiu Liang (Second Author): Writing-Reviewing and Editing.

Mingming Yan (Third Author): Data Collection and Supervision.

Jiancheng Li (Corresponding Author): Project administration, Funding Acquisition and Supervision.

All authors reviewed the manuscript.

Bussu F, Gallus R, Navach V, et al: Contemporary role of pectoralis major regional flaps in head and neck surgery. Acta Otorhinolaryngol Ital 34:327–41, 2014
Opoku-Agyeman J, Perez S, Behnam A, et al: Reconstruction of sternoclavicular defect with completely detached pectoralis major flap. J Surg Case Rep 2019:rjz122, 2019
Muñoz-Largacha JA, Slama J, Kalish J, et al: Approach to resection of sternoclavicular tumor abutting the common carotid artery in irradiated field. J Thorac Dis 10:E38-e41, 2018
Zhang Y, Wang W, Xu X, et al: Impact of Radiotherapy Pattern on the Prognosis of Stage IV Lung Adenocarcinomas Harboring EGFR Mutations. Cancer Manag Res 13:3293–3301, 2021
He Z, Liu J, Ma Y, et al: Anlotinib Combined with Cranial Radiotherapy for Non-Small Cell Lung Cancer Patients with Brain Metastasis: A Retrospectively, Control Study. Cancer Manag Res, 2021
Liu M, Liu W, Yang X, et al: Pectoralis Major Myocutaneous Flap for Head and Neck Defects in the Era of Free Flaps: Harvesting Technique and Indications. Sci Rep 7:46256, 2017
Inhestern L, Beierlein V, Bultmann JC, et al: Anxiety and depression in working-age cancer survivors: a register-based study. BMC Cancer 17:347, 2017
Amin MB, Greene FL, Edge SB, et al: The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin 67:93–99, 2017
Lewis JS, Jr., Beadle B, Bishop JA, et al: Human Papillomavirus Testing in Head and Neck Carcinomas: Guideline From the College of American Pathologists. Arch Pathol Lab Med 142:559–597, 2018
Abel E, Silander E, Nyman J, et al: Long-Term Aspects of Quality of Life in Head and Neck Cancer Patients Treated With Intensity Modulated Radiation Therapy: A 5-Year Longitudinal Follow-up and Comparison with a Normal Population Cohort. Adv Radiat Oncol 5:101–110, 2020
Gill A, Givi B, Moore MG: AHNS Series - Do you know your guidelines?: Assessment and management of malnutrition in patients with head and neck cancer: Review of the NCCN Clinical Practice Guidelines In Oncology (NCCN Guidelines). Head Neck 41:577–583, 2019
Nishi Y, Rikimaru H, Kiyokawa K, et al: Development of the pectoral perforator flap and the deltopectoral perforator flap pedicled with the pectoralis major muscle flap. Ann Plast Surg 71:365–71, 2013
Romano A, Sbordone C, Iaconetta G, et al: The pectoralis major myocutaneous pedicled flap: a refined surgical technique. J Craniofac Surg 24:330–4, 2013
Momeni A, Kovach SJ: Important considerations in chest wall reconstruction. J Surg Oncol 113:913–22, 2016
Nariai Y, Odawara S, Ichiyama T, et al: Fracture of the Clavicle following Radical Neck Dissection and Reconstruction Using Pectoralis Major Myocutaneous Flap Accompanied by Postoperative Radiotherapy. Craniomaxillofac Trauma Reconstr 11:138–141, 2018
Gavid M, Mayaud A, Timochenko A, et al: Topographical and functional anatomy of trapezius muscle innervation by spinal accessory nerve and C2 to C4 nerves of cervical plexus. Surg Radiol Anat 38:917–22, 2016
Svenberg Lind C, Lundberg B, Hammarstedt Nordenvall L, et al: Quantification of Trapezius Muscle Innervation During Neck Dissections: Cervical Plexus Versus the Spinal Accessory Nerve. Ann Otol Rhinol Laryngol 124:881–5, 2015
He Z, Jiang H, Zhang X, et al: Nano-delivery vehicle based on chlorin E6, photodynamic therapy, doxorubicin chemotherapy provides targeted treatment of HER-2 negative, ανβ3-positive breast cancer. Pharmacol Res 160:105184, 2020
He Z, Zhang H, Cui Z, et al: A case of chemorefractory metastatic type AB thymoma sensitive to helical tomotherapy. Ann Transl Med 7:274, 2019
Edwards SP: Margin Analysis-Has Free Tissue Transfer Improved Oncologic Outcomes for Oral Squamous Cell Carcinoma? Oral Maxillofac Surg Clin North Am 29:377–381, 2017
Romero Y, Castillejos-López M, Romero-García S, et al: Antitumor Therapy under Hypoxic Microenvironment by the Combination of 2-Methoxyestradiol and Sodium Dichloroacetate on Human Non-Small-Cell Lung Cancer. Oxid Med Cell Longev 2020:3176375, 2020
Li J, Song P, Yang D, et al: Complicated intraoral defects: reconstruction using a three-paddle perforator free flap. A case report. Br J Oral Maxillofac Surg 58:355–357, 2020
Yoo H, Shin DW, Jeong A, et al: Perceived social support and its impact on depression and health-related quality of life: a comparison between cancer patients and general population. Jpn J Clin Oncol 47:728–734, 2017
Bachmann AS, Zaunbauer AC, Tolke AM, et al: Well-being and quality of life among oral cancer patients - Psychological vulnerability and coping responses upon entering initial treatment. J Craniomaxillofac Surg 46:1637–1644, 2018
Tirelli G, Gatto A, Bonini P, et al: Prognostic indicators of improved survival and quality of life in surgically treated oral cancer. Oral Surg Oral Med Oral Pathol Oral Radiol, 2018
Lahtinen S, Koivunen P, Ala-Kokko T, et al: Swallowing-related quality of life after free flap surgery due to cancer of the head and neck. Eur Arch Otorhinolaryngol 276:821–826, 2019
Tirelli G, Gatto A, Bonini P, et al: Prognostic indicators of improved survival and quality of life in surgically treated oral cancer. Oral Surg Oral Med Oral Pathol Oral Radiol:S2212-4403(18)30052-X, 2018

No competing interests reported.

Download PDF

Version 1

posted

You are reading this latest preprint version

Quality of life and survival assessments of tissue defect salvage reconstruction with pectoralis major myocutaneous flap following oral-maxillofacial malignancy resection

Status:

Version 1

Abstract

Figures

1. Introduction

2. Materials and methods

2.1 Clinical information

2.2 Surgical technique

2.2.1 Primary lesion treatment

2.2.2 Preparation of PMMFs and cranial and maxillofacial reconstruction

2.3 Postoperative treatment

2.4 Postoperative follow-up

2.5 Functional assessment of oncology treatment

2.6 Statistical analyses

3. Results

3.1 Craniomaxillofacial reconstruction and patient recovery

3.2 Postoperative survival rate

3.3 Pre - and postoperative QOL

4. Discussion

Declarations

References

Additional Declarations

Status:

Version 1