PECTORALIS MAJOR AND OTHER MYOFASCIAL/ MYOCUTANEOUS FLAPS IN HEAD AND NECK CANCER RECONSTRUCTION: EXPERIENCE WITH 437 CASES AT A SINGLE INSTITUTION Jose ´ Guilherme Vartanian, MD, Andre ´ Lopes Carvalho, MD, PhD, Solange Maria T. Carvalho, MD, Lia Mizobe, DDS, Jose ´ Magrin, MD, PhD, Luiz Paulo Kowalski, MD, PhD Head and Neck Surgery and Otorhinolaryngology Department, Centro de Tratamento e Pesquisa Hospital do Ca ˆ ncer A. C. Camargo, Rua Professor Antonio Prudente, 211, 01509-900-Sa ˜ o Paulo, Brazil. E-mail: lp _ kowalski@uol.com.br Accepted 11 May 2004 Published online 3 August 2004 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/hed.20101 Abstract: Background. Pectoralis major and other myofas- cial/myocutaneous flaps have been recognized as important reconstructive methods in head and neck cancer surgery. Even with the worldwide use of free flaps, they are still the mainstay reconstructive procedures in many centers. Methods. We retrospectively analyzed the records of pa- tients with head and neck cancer who underwent an immediate reconstruction with pectoralis major or other myofascial/myocu- taneous flaps at a tertiary cancer center from 1982 to 1998. Results. A total of 437 patients were reviewed. Three hun- dred seventy-one patients underwent pectoralis major myocuta- neous flaps; of these, 335 (90.3%) were men, with a median age of 56 years (range, 24 – 91 years). Tumors were located at the oral cavity and oropharynx in 246 patients (66.3%). Most tumors were at an advanced stage at presentation (T3 – T4 in 60.9%). The flaps were used to cover mucosal defects in 280 patients (75.5%), skin defects in 62 patients (16.7%), and both in 29 pa- tients (7.8%). In most patients, the flap was transferred to the head and neck region through a subclavicular tunnel. The overall complication rate was 36.1%, with 2.4% of cases involving total flap necrosis. Conclusion. To date, this is the largest published series of patients who underwent reconstruction with a pectoralis major flap. Our results show that this flap remains an important reconstructive method, and it can be done with low risk and acceptable morbidity. A 2004 Wiley Periodicals, Inc. Head Neck 26: 1018 – 1023, 2004 Keywords: head and neck neoplasms; head and neck reconstruction; pectoralis major myocutaneous flap; pedicled flap; complications Pedicled myocutaneous flaps have been recog- nized as one of the most important reconstruc- tive methods in major head and neck cancer surgery. Since the first description by Ariyan 1 in the 1970s, the pectoralis major myocutaneous flap has been the most commonly used. The main reasons for this are the simple technical aspects, versatility, and proximity to the head and neck region. 2–5 However, in the past two decades, reconstruction with microsurgical free flaps has been broadly used. The free flaps can Correspondence to: L. P. Kowalski B 2004 Wiley Periodicals, Inc. HEAD & NECK December 2004 1018 Myocutaneous Flaps