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Artigos Originais • Rev. Col. Bras. Cir. 26 (5) • Out 1999 • https://doi.org/10.1590/S0100-69911999000500009   copiar

Viabilidade do retalho miofascial (RMF) de grande peitoral em cabeça e pescoço: estudo de 14 casos

Viability of major pectoralis miofascial flap in malignant neoplasias of head and neck: study of 14 cases

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumos

A maioria dos retalhos utilizados na reconstrução dos grandes defeitos pós-tratamento cirúrgico isolado ou associado à radioterapia no câncer da cabeça e pescoço levou os autores a estudar a viabilidade do RMF em 14 pacientes, atendidos no Serviço de Cabeça e Pescoço do Hospital Celso Pierro, PUCCAMP, Campinas. Todos eram portadores de lesões epidermóides avançadas no estádio IV, localizadas na boca (dez), hipofaringe (dois), laringe (um) e pescoço (um). Através do teste exato de Fisher (p< 0,05), aferiu-se a existência ou não da relação da viabilidade do RMF com a idade, estado nutricional, tratamento prévio. Nestes 14 pacientes, foram empregados 16 retalhos, 13 deles viáveis (81,2%) e três (18,8%) com necrose total, não havendo associação entre a viabilidade e a necrose e a idade (p=1,0). Quanto à relação com o tratamento prévio com quimioterapia (três casos) e radioterapia (dois casos), estes não foram significantes (p=0,547).

Retalho miofascial; Músculo Grande Peitoral; Reconstrução

The great incidence of advanced squamous cell carcinoma of the mouth, pharynx, larynx and neck, justifies the extensive resections that are carried out by the authors at the Head and Neck Service of Hospital Celso Pierro PUCCAMP - São Paulo. Major pectoralis myofascial flap were used to manage 14 patients with advanced head and neck squamous cell carcinoma of the mouth (ten cases), pharynx (two cases); larynx (one case) and neck (one case). There was no complications in 81.2% and in 18.8% total necrosis of the flap was observed. We conclude that viability, age and necrosis or fibrosis were not associated with the success of this procedure (p=1.0), and previous treatment (chemoradiotheraphy and or radiotherapy alone) had no significant relation with flap viability (p=0.547).

Myofascial flap; Major pectoralis muscle; Reconstruction

ARTIGOS ORIGINAIS

Viabilidade do retalho miofascial (RMF) de grande peitoral em cabeça e pescoço - Estudo de 14 casos

Viability of major pectoralis miofascial flap in malignant neoplasias of head and neck - Study of 14 cases

José Gonzaga Teixeira CamargoI; Abrão Rapoport, TCBC-SPII; José Francisco Salles ChagasIII; José Luis Braga Aquino, TCBC-SPI

ICirurgião do Serviço de Cabeça e Pescoço, Hospital Celso Pierro - PUCCAMP - São Paulo

IICirurgião do Serviço de Cabeça e Pescoço, Hospital Heliópolis - HOSPHEL - São Paulo

IIIChefe do Serviço de Cabeça e Pescoço, Hospital Celso Pierro - PUCCAMP - São Paulo

Endereço para correspondência Endereço para correspondência: Prof. Abrão Rapoport Praça Amadeu Amaral, 47 - cj. 82 01327-010 - São Paulo - SP

RESUMO

A maioria dos retalhos utilizados na reconstrução dos grandes defeitos pós-tratamento cirúrgico isolado ou associado à radioterapia no câncer da cabeça e pescoço levou os autores a estudar a viabilidade do RMF em 14 pacientes, atendidos no Serviço de Cabeça e Pescoço do Hospital Celso Pierro, PUCCAMP, Campinas. Todos eram portadores de lesões epidermóides avançadas no estádio IV, localizadas na boca (dez), hipofaringe (dois), laringe (um) e pescoço (um). Através do teste exato de Fisher (p< 0,05), aferiu-se a existência ou não da relação da viabilidade do RMF com a idade, estado nutricional, tratamento prévio. Nestes 14 pacientes, foram empregados 16 retalhos, 13 deles viáveis (81,2%) e três (18,8%) com necrose total, não havendo associação entre a viabilidade e a necrose e a idade (p=1,0). Quanto à relação com o tratamento prévio com quimioterapia (três casos) e radioterapia (dois casos), estes não foram significantes (p=0,547).

Unitermos: Retalho miofascial; Músculo Grande Peitoral; Reconstrução.

ABSTRACT

The great incidence of advanced squamous cell carcinoma of the mouth, pharynx, larynx and neck, justifies the extensive resections that are carried out by the authors at the Head and Neck Service of Hospital Celso Pierro PUCCAMP - São Paulo. Major pectoralis myofascial flap were used to manage 14 patients with advanced head and neck squamous cell carcinoma of the mouth (ten cases), pharynx (two cases); larynx (one case) and neck (one case). There was no complications in 81.2% and in 18.8% total necrosis of the flap was observed. We conclude that viability, age and necrosis or fibrosis were not associated with the success of this procedure (p=1.0), and previous treatment (chemoradiotheraphy and or radiotherapy alone) had no significant relation with flap viability (p=0.547).

Key words: Myofascial flap; Major pectoralis muscle; Reconstruction.

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Full text available only in PDF format.

REFERÊNCIAS

1. Bakamjiam VY. A technique for primary reconstruction of the palate after radical maxillectomy for cancer. Plast Reconst Surg 1963; 31:103-117.

2. Demergasso FD, Piazza MV. Colgajo cutaneo aislado a pediculo muscular em cirurgia reconstructiva por cancer de cabeza y cuello. Rev Argent Cirug 1977;32:27-29.

3. Aryan S. The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck. Plast Reconst Surg 1979; 63: 73- 81.

4. Robertson MS, Robinson IM. Pharyngoesophageal reconstruction - Is askin-lined pharynx necessary? Arch Otolaryngol 1985;111:375- 377.

5. Robertson MS, Allison RS. The pectoralis major muscle flap in head and neck reconstruction. Aust N Z J Surg 1986;112:297-301.

6. Moloy PI. Reconstruction of intermediate sized mucosal defects with the pectoralis major myofascial fIap. J Otolaryngol 1989;18: 32-35.

7. Grevers G. Der myofasziale pektoralis-major-lappen zur defektdeckung im cavum oris. Laryngo-Rhino-Otol 1994;73:193-197.

8. Shindo ML, Constantino PD, Friedman CD, et al. The pectoralis major miofascial flap for intra-oral and pharyngeal reconstruction. Arch Otolaryngol Head Neck Surg 1992; 118: 707-711.

9. Leernans CR, Balm AJM, Gregor RT, et al. Management of carotid artery exposure with pectoralis major myofascial fIap transfer and split-thickness skin coverage. J Laryngol Otol 1995;109: 1.176- 1.180.

10. Zbar RIS, Funk GF, McCulloch TM, et al. Pectoralis major myofascial flap: a valuable tool in contemporary head and neck reconstruction. Head Neck 1997;19:412-418.

11. Johnson MA, Langdon JD. Is skin necessary for intra-oral reconstruction with myocutaneous fIaps? Br J Oral Maxillofac Surg 1990;18: 299-301.

12. Baek S, Lawson W, Biller HF. An analysis of 133 pectoralis major myocutaneous flaps. Plast Recontr Surg 1982;69:460-467.

13. Calcaterra TC. Bilateral omohyoid muscle flap reconstruction for anterior commissure cancer. Laryngoscope 1987;97: 810-813.

14. Birt BD, Antonyshyn O, Oruss JS. The temporalis muscle flap for head and neck reconstruction. J Otolaryngol 1987;16:179-194.

15. Komnda FC, McMahon MF, Jemstrom VR. The temporalis muscle flap for intra-oral reconstruction. Arch Otolaryngol Head Neck Surg 1987;113:740-743.

16. Shagets FW, Panje WR, Shore JW. Use of temporalis muscle flap in complicated defects of head and face. Arch Otolaryngol Head Neck Surg 1986;112:60-65.

17. Philipps JG, Postlethwaite N, Peckitt N. The pectoralis major muscle flap without skin intra-oral reconstruction. Br J Oral Maxillofac Surg 1988; 26:479-485.

18. Friedrich W, Lierse W, Herberhold C. Myocutaneous vascular territory of the thoracromial artery. Acta Anat 1988;131:284-291.

19. Murakami Y, Saito S, Ikari T, et al. Esophageal reconstruction with a skin-grafted pectoralis major muscle fIap. Arch Otolaryngol Head Neck Surg 1982;108:719-722.

Recebido em 16/12/98

Aceito para publicação em 13/9/99

Trabalho realizado no Serviço de Cabeça e Pescoço do Hospital Celso Pierro - PUCCAMP - São Paulo.

  • 1. Bakamjiam VY. A technique for primary reconstruction of the palate after radical maxillectomy for cancer. Plast Reconst Surg 1963; 31:103-117.
  • 2. Demergasso FD, Piazza MV. Colgajo cutaneo aislado a pediculo muscular em cirurgia reconstructiva por cancer de cabeza y cuello. Rev Argent Cirug 1977;32:27-29.
  • 3. Aryan S. The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck. Plast Reconst Surg 1979; 63: 73- 81.
  • 4. Robertson MS, Robinson IM. Pharyngoesophageal reconstruction - Is askin-lined pharynx necessary? Arch Otolaryngol 1985;111:375- 377.
  • 5. Robertson MS, Allison RS. The pectoralis major muscle flap in head and neck reconstruction. Aust N Z J Surg 1986;112:297-301.
  • 6. Moloy PI. Reconstruction of intermediate sized mucosal defects with the pectoralis major myofascial fIap. J Otolaryngol 1989;18: 32-35.
  • 7. Grevers G. Der myofasziale pektoralis-major-lappen zur defektdeckung im cavum oris. Laryngo-Rhino-Otol 1994;73:193-197.
  • 8. Shindo ML, Constantino PD, Friedman CD, et al. The pectoralis major miofascial flap for intra-oral and pharyngeal reconstruction. Arch Otolaryngol Head Neck Surg 1992; 118: 707-711.
  • 9. Leernans CR, Balm AJM, Gregor RT, et al. Management of carotid artery exposure with pectoralis major myofascial fIap transfer and split-thickness skin coverage. J Laryngol Otol 1995;109: 1.176- 1.180.
  • 10. Zbar RIS, Funk GF, McCulloch TM, et al. Pectoralis major myofascial flap: a valuable tool in contemporary head and neck reconstruction. Head Neck 1997;19:412-418.
  • 11. Johnson MA, Langdon JD. Is skin necessary for intra-oral reconstruction with myocutaneous fIaps? Br J Oral Maxillofac Surg 1990;18: 299-301.
  • 12. Baek S, Lawson W, Biller HF. An analysis of 133 pectoralis major myocutaneous flaps. Plast Recontr Surg 1982;69:460-467.
  • 13. Calcaterra TC. Bilateral omohyoid muscle flap reconstruction for anterior commissure cancer. Laryngoscope 1987;97: 810-813.
  • 14. Birt BD, Antonyshyn O, Oruss JS. The temporalis muscle flap for head and neck reconstruction. J Otolaryngol 1987;16:179-194.
  • 15. Komnda FC, McMahon MF, Jemstrom VR. The temporalis muscle flap for intra-oral reconstruction. Arch Otolaryngol Head Neck Surg 1987;113:740-743.
  • 16. Shagets FW, Panje WR, Shore JW. Use of temporalis muscle flap in complicated defects of head and face. Arch Otolaryngol Head Neck Surg 1986;112:60-65.
  • 17. Philipps JG, Postlethwaite N, Peckitt N. The pectoralis major muscle flap without skin intra-oral reconstruction. Br J Oral Maxillofac Surg 1988; 26:479-485.
  • 18. Friedrich W, Lierse W, Herberhold C. Myocutaneous vascular territory of the thoracromial artery. Acta Anat 1988;131:284-291.
  • 19. Murakami Y, Saito S, Ikari T, et al. Esophageal reconstruction with a skin-grafted pectoralis major muscle fIap. Arch Otolaryngol Head Neck Surg 1982;108:719-722.

  • Endereço para correspondência:

    Prof. Abrão Rapoport
    Praça Amadeu Amaral, 47 - cj. 82
    01327-010 - São Paulo - SP

    • Datas de Publicação

    • Publicação nesta coleção
      24 Nov 2009
    • Data do Fascículo
      Out 1999

    Histórico

    • Aceito
      13 Set 1999
    • Recebido
      16 Dez 1998
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