Assessment of Shoulder Morbidity Following Pectoralis Major Myocutaneous Flap Harvest in Head and Neck Cancer Reconstruction: A Prospective Observational Study
Basant Mohan Singhal, Vishal Kewlani, Yogesh VermaObjectives:
Pectoralis Major Mocutaneous (PMMC) flap remains a reliable option for head and neck reconstruction in high-volume and resource-limited settings. However, it may lead to significant donor site morbidity. This study assessed postoperative shoulder dysfunction following PMMC harvest using disabilities of the arm, shoulder, and hand (DASH) scoring, range of motion (ROM), and muscle power evaluation.
Material and Methods:
A prospective observational study was conducted in 44 oral cancer patients undergoing composite resection between January and December 2024. Group 1 (n=34) underwent PMMC reconstruction; Group 2 (n=10) had primary closure or local flaps. In all patients, DASH scores were assessed preoperatively and 6 months postoperatively, along with ROM measured by goniometry, and muscle power by Medical Research Council (MRC) scale. Statistical analysis was done using Student’s t-test, with p < 0.05 considered significant.
Results:
Postoperative DASH scores were significantly higher in Group 1 (mean 37.77, SD = 6.54) versus Group 2 (mean 26.33; p = 0.002). More than 20% reduction in ROM—especially flexion and adduction—was associated with moderate-to-severe upper-limb disability (DASH 31 or >). A postoperative decrease in muscle power >1 on the MRC scale was also significantly associated with high morbidity in the PMMC group.
Conclusion:
PMMC flap harvest causes significant shoulder morbidity with a reduction in ROM, muscle strength, and quality of life. Greater disability in terms of DASH score was observed when the dominant limb was used for PMMC Flap Harvest. Quality of life issues are important when assessing the outcome of any reconstruction, as it may impact activities of daily living and occupational performance.