Table 1 Summary of our PIMOC Series.
Patient | Diagnosis | Stage | Background | Initial treatment | Previous recon-structions | Adju-vant Tx | Surgery performed | Defect | Recon-struction | Flap compo-sition | Complica-tions and treatment | LOS | Outcome | Follow-up |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1. RSN M, 31 y | Cranial base pleomorph. sarcoma | Grade III | Malnutrition Gastrostomy | Extended field RTX + bilateral neck dissection | None | CTX RTX | Left partial mandibulo-maxillectomy, cranial base, nasal and oropharynx, skin resection | Communication between dura and nasal/oral cavity, cheek skin | Immediate L extended pedicle VRAM | VRAM | OCF: flap adv DS: no complications | 45 days | Fair contour, fair oral intake and speech | 11 mo death: tumor recurrence |
2. RGS, M, 42 y | Anterior gingiva and mandible SCC | T4N1M0 | Tobacco Alcohol Tuberculosis Gastrostomy | Anterior CMR with skin + bilateral neck dissection | Free ALT, Free LD, free IC, trapezius, SCM, Pectoralis major + mandibular plate | CTX RTX | Debridement previous flap + reconstruction plate removal | Angle to angle mandibulectomy, oral cavity, chin skin + oral incompetence | Delayed R PIMOC | 6th rib, 2 skin islands: SSEP + VRAM | OCF: flap adv DS: no complications | 28 days | Good contour, good oral intake and speech | 12 mo death: tumor recurrence |
3. CA, M, 54 y | Anterior gingiva and mandible SCC | T4N2cM0 | Tobacco Alcohol Gastrostomy | Anterior CMR + bilateral neck dissection | Free fibula × 2, bilateral oral mucosa flap, SCM | CTX RTX | Reconstitution of oromandibular defect | Andy Gump deformity; angle to angle mandibulectomy, FOM, chin skin | Delayed R PIMOC | 6th rib, 2 skin islands: IC perf + SSEP | Cervical skin dehiscence: flap adv DS: no complications | 27 days | Good contour, good oral intake and speech | 3 mo death: respiratory infection |
4. VOG, M, 68 y | Left retromolar mandible SCC | T4N2aM1 | Tobacco Alcohol Gastrostomy Gastrectomy from gastric ulcer | Left posterior CMR + bilateral neck dissection | Free fibula, free TFL, Pectoralis major, supra-clavicular, deltopectoralis, tongue flap | CTX RTX | Reconstitution of oromandibular defect | Left mandibulectomy, oropharynx, cheek skin + tongue adherence | Delayed R PIMOC | 7th rib, 2 skin islands: IC perf + VRAM | Facial nerve neuropraxia OCF: flap adv DS sternal sinus: debride | 25 days | Good contour, fair oral intake and speech | 20 mo cranial base recurrence |
5. CEO, M, 54 y | Tongue and FOM SCC | T4aN2bM0 | Tobacco Alcohol Drug Abuse Gastrostomy | Anterior CMR + bilateral neck dissection | Free fibula × 2 pectoralis major supra-clavicular tongue flap, lip flap | CTX RTX | Reconstitution of oromandibular defect | Andy Gump deformity; angle to angle mandibulectomy, FOM, chin skin | Delayed R PIMOC | 7th rib, 2 skin islands: IC perf + VRAM | Cervical skin dehiscence: flap adv DS: no complications | 35 days | Good contour, fair oral intake and speech | 14 mo speech therapy rehabilitation |
