The pectoralis major myocutaneous flap moves chest muscle, with or without a paddle of skin, up to the mouth and neck. Across India it is the workhorse of head and neck reconstruction after surgery for oral cancer.
A PMMC flap uses pectoralis major, the large muscle of the chest, along with the skin over it, to rebuild tissue removed during oral cancer surgery. Muscle and skin travel together on one artery, passing under the skin of the chest and neck into the mouth. Surgeons value it because it is dependable, quick and needs no microsurgery.
Surgery for cancer of the mouth often removes a great deal of tissue at once, including cheek lining, part of the jaw, floor of the mouth and neck nodes. Something has to fill that gap, seal the mouth off from the neck and protect the large blood vessels underneath. Pectoralis major sits within easy reach, has a strong and predictable artery, and can be swung up beneath the skin of the chest and neck to do exactly that.
Dependability is why the technique remains so common in India. A free flap needs microsurgery, a long operating list and intensive monitoring afterwards. This flap can be raised by the same team in the same sitting, tolerates a difficult neck, and gives a result that works well for patients who are frail, anaemic or already advanced in their disease.
Limits do exist. Muscle and chest fat together make the flap thick, so it suits broad defects rather than delicate ones. In women the skin paddle comes from breast tissue, which needs a frank conversation beforehand. Even so, for sealing the mouth and covering the neck safely, few options are as reliable.
This flap suits large defects that need reliable, well supplied tissue quickly. Thin and delicate reconstructions are better served elsewhere.
The tumour is removed with clear margins and the neck nodes are addressed. Only when the defect is final is the flap planned, so it is sized to the true gap.
A paddle of chest skin is drawn over the lower part of the muscle, positioned so the chest can be closed directly afterwards and so the paddle reaches the mouth without tension.
Pectoralis major is lifted off the chest wall while the vessels running on its undersurface are protected. Stitches hold the paddle to the muscle so the two do not shear apart.
Flap and pedicle pass under the skin of the upper chest and neck, above the collarbone, and are delivered into the mouth. That tunnel is made wide enough that the pedicle is never squeezed.
The paddle is sutured to the mouth lining or skin edges, drains are placed, and the chest is closed directly. A feeding tube is usually passed so the mouth can rest.
Care is in hospital with drains, a feeding tube and close monitoring of the flap. Chest and neck discomfort is expected and managed with regular pain relief.
Drains come out as output falls, and swallowing is tested before feeding by mouth restarts. Chest sutures are removed towards the end of this period.
Wounds are usually healed. Radiotherapy often begins around now if it is planned, and shoulder exercises continue at home.
Bulk in the mouth settles, and speech and swallowing improve with therapy. Chest strength recovers gradually, though some weakness on pushing may remain.
Closure of the defect and protection of the neck are achieved reliably, which is the main purpose. Appearance is functional rather than delicate, and the reconstructed area often looks fuller on one side. Speech and swallowing improve with therapy but rarely return to how they were before the cancer. Chest strength recovers over months, with some weakness on pushing. The chest scar is lifelong.
This is major surgery, usually done alongside cancer clearance, so the risks are those of both procedures together.
Two sites need looking after here. The chest is the donor area and the mouth or neck is the recipient, and each has its own routine.
Each has a place. Where general health is poor, vessels are scarred or quick dependable closure is needed, this flap is often the wiser choice.
Other muscles take over most of the work. Some weakness on pushing can remain, though everyday activity is usually unaffected once exercises are done.
Muscle thins over months as it loses its nerve supply, so the reconstruction usually becomes less full. Where fullness persists, a small thinning procedure can help.
Reliable closure is what allows radiotherapy to start on time. A wound that breaks down causes far longer delays than a well planned flap does.
Head and neck reconstruction at Elegance Clinic in Surat is planned alongside the cancer team, and Dr. Ashutosh Shah explains to families what the flap can restore, what it cannot, and how feeding and speech will be managed.
Technique pages do not carry a price of their own, because a PMMC flap is a method of reconstruction used within a larger operation. Cost follows the cancer surgery it accompanies, the extent of the resection, the length of hospital stay and any intensive care needed.
Bands for the underlying treatments are shown on their own pages, and a written estimate is prepared after assessment so the family can plan before admission.
These are the questions that come up most often in consultation. If yours is not here, send it on WhatsApp and the team will reply, usually the same day.
Ask your question →A technique has no separate price. The total depends on the cancer operation it forms part of, the extent of removal, hospital stay, drains and feeding support. A written estimate is prepared after assessment so families can plan ahead.
This flap is often chosen precisely for such patients, since it avoids microsurgery and shortens the operation. Risks remain, including partial paddle loss, infection and chest wound problems, and they rise when nutrition is poor.
Most patients need several days up to about two weeks, depending on drains, feeding and how the flap settles. Radiotherapy, when planned, usually begins some weeks after the wounds have healed.
Improvement is usual with speech and swallowing therapy, though function rarely returns exactly to what it was before the cancer. Bulk in the mouth settles over months, and a thinning procedure sometimes helps.
Thin, delicate reconstructions such as the tongue tip are better served by other tissue. Previous chest surgery or chest radiotherapy affecting the pectoral vessels, and defects needing bone replaced, also point elsewhere.
Some weakness on pushing movements can persist, since a chest muscle has been moved. Other muscles compensate for most daily tasks, and the exercises started in hospital make a clear difference if continued.
The extent of the planned removal, what the flap will restore, feeding through a tube, likely hospital stay and the chest scar are all covered. For women, taking the skin paddle from the breast is discussed openly beforehand.
Seeing patients from across the city and beyond: read about the practice on the plastic surgeon in Surat page, or check what a written estimate covers on the costs and insurance page.
