Dumbbell-Shaped Bipaddled Pectoralis Major Myocutaneous Flap for Composite Commissural Defects: A Defect-Driven Modification

Subrat Kumar Padhiary; Gunjan Srivastava; Pratikshya Kothia; Rupsa Das

doi:10.1016/j.joms.2024.10.016

Dumbbell-Shaped Bipaddled Pectoralis Major Myocutaneous Flap for Composite Commissural Defects: A Defect-Driven Modification

J Oral Maxillofac Surg. 2024 Oct 28:S0278-2391(24)00912-1. doi: 10.1016/j.joms.2024.10.016. Online ahead of print.

Authors

Subrat Kumar Padhiary¹, Gunjan Srivastava², Pratikshya Kothia³, Rupsa Das⁴

Affiliations

¹ Professor, Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, India. Electronic address: [email protected].
² Professor, Department of Prosthodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, India.
³ Assistant Professor, Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, India.
⁴ Assistant Professor, Department of Oral Medicine & Radiology, Institute of Dental Sciences, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, India.

PMID: 39551084
DOI: 10.1016/j.joms.2024.10.016

Abstract

Pectoralis major myocutaneous flap (PMMF) has been a workhorse in orofacial reconstruction. Although microvascular tissue transfer has gained popularity in major tertiary centers, several infrastructural factors limit its use in many facilities, particularly in developing countries with high caseloads. Numerous modifications have been made to the PMMF since its inception. Here, we present a novel technique for reconstructing composite commissural defects with PMMF by modifying the skin paddle design to a dumbbell shape. Both ends of the paddle are used to line intraoral and extraoral defects, while the constricted middle portion recreates the commissure. We report the outcomes of a cohort of 7 patients treated at our institution, describing the modified PMMF design, harvesting, and in-setting techniques used in oral carcinoma cases involving the commissure. We have detailed the study outcomes for each patient, including the various complications related to the flap, donor, and recipient sites.