Comparison Of The Application Of Pedicled Pectoralis Major Myocutaneous Flap And Free Anterolateral Thigh Flap In Reconstruction Of Postoperative Defects Of Head And Neck Malignant Tumors

Objective:To evaluate the application effects of free Anterolateral Thigh Flap(Free Anterolateral Thigh Flap,ALT)and(pedicled Pectoralis Major Myocutaneous Flap,PMMF)in the repair and reconstruction of head and neck malignant tumors.Methods: The clinical and pathological data of 111 patients who underwent skin flap repair and reconstruction after head and neck malignant tumor resection from December 2012 to December 2020 in the Head and Neck Surgery Ward of Liaoning Cancer Hospital were retrospectively analyzed and studied.111 patients were divided into two groups according to the different ways of skin flap repair after operation,69 cases of PMMF and 42 cases of ALT.All 111 patients underwent radical tumor resection and neck lymph node dissection,combined with postoperative radiotherapy and chemotherapy.Record and observe the patient’s perioperative period(operation duration and flap size),flap blood supply survival,flap complications,donor site complications,and systemic complications.The modified version of Washington University Quality of Life Questionnaire was used to evaluate the quality of life of patients before and 6 months after surgery.The scale includes12 items such as swallowing,chewing,mood,appearance,pain,language,etc.,each of which uses 3 to 5 grades,ranging from 0 to 100 points.The total score is converted to a percentage system.The higher the score,the higher the quality of life.SPSS26.0 software was used for statistical analysis,independent sample t test was performed for comparison of measurement data between groups,count data was described by n(%),and chi-square test or Fisher’s exact probability test was performed: P<0.05 means statistically significant significance.Results: In 111 cases of flap repair(69 cases of pedicled pectoralis major muscle flap,42 cases of free anterolateral thigh flap),the survival rate of pedicled pectoralis major muscle flap was 100%,and 3 cases of free anterolateral thigh flap were necrotic.The survival rate was 92.86%.There were 4 cases of local flap margin necrosis,3 cases of PMMF(1 case each of hypopharyngeal cancer,oral cancer,and oropharyngeal cancer),and 1 case of ALT(maxillary sinus malignant tumor).In terms of operation time,the pedicled pectoralis major myocutaneous flap group was lower than the free anterolateral thigh flap group(t=-4.205,P<0.001);the size of the free anterolateral thigh flap group was significantly higher than that of the pedicled pectoralis major myocutaneous flap group(t=-3.101,P=0.003<0.05).Postoperative flap complications(infection,hematoma)PMMF in 8 cases,6cases of ALT;donor site complications(infection,skin shedding,effusion,dehiscence,bleeding)PMMF in 3 cases,6 cases of ALT;systemic complications(multiple bacterial infections,cardiopulmonary insufficiency,aspiration pneumonia,respiratory failure,pharyngeal fistula,hypoxemia)PMMF in 22 cases,ALT in 16 cases.After Fisher’s exact probability test and Chi-square test,the pedicled pectoralis major myocutaneous flap(PMMF)and free anterolateral thigh flap(ALT)were associated with flap complications(infection,hematoma,P=0.8>0.05);donor site complications(infection,peeling skin,effusion,cracking,bleeding,P=0.1>0.05);systemic complications(multiple bacterial infections,cardiopulmonary insufficiency,aspiration pneumonia,respiratory failure,pharyngeal fistula,hypoxemia P=0.5>0.05),there was no statistically significant difference in the incidence between groups.The preoperative scale scores(PMMF: 67.82 ± 11.54,ALT:66.59 ± 10.56)were not statistically different between the two groups(P=0.537>0.05),and the scale scores(PMMF: 83.42 ± 13.76,ALT: 80.23 ±11.53),there was no statistically significant difference in the increase range between the two groups(P=0.584>0.05).At the same time,the confidence interval of the relative risk of complications in the three groups of flap complications,donor site complications,and systemic complications all included 1,which was not statistically significant.Conclusions:1.Free anterolateral thigh flap(ALT)and pedicled pectoralis major myocutaneous flap(PMMF)in the postoperative repair and reconstruction of head and neck malignant tumors,the survival rate of the two groups of flaps is higher,which can effectively improve the patients after surgery Quality of Life.2.There is no statistically significant difference between the two in terms of postoperative complications and quality of life.When both repair methods can be selected,PMMF has a short operation time and sufficient tissue volume without microsurgical techniques.If PMMF cannot be repaired ALT was selected for the corresponding defect,and the incidence of necrosis on the edge of the ALT flap was lower.3.In clinical work,individualized repair and reconstruction methods should be selected based on the location of the defect and the histological characteristics of the need to be repaired.For example,some patients with hypopharyngeal cancer often choose ALT to repair the defect.The skin flap is relatively thin,which is ideal in terms of preserving laryngeal function,and PMMF is more bloated.