Is Pectoralis Major Myocutaneous flap possible in presence of an ipsilateral chest wall implanted Cardiac pacemaker?

Mainak Mallik; Saptarshi Bhattacharya; Suvadip Chakrabarti; Tapas Kumar Kar; Gopal Chandra Ghosh; Pritha Rakshit

Volume : IX, Issue : II, February - 2020

Is Pectoralis Major Myocutaneous flap possible in presence of an ipsilateral chest wall implanted Cardiac pacemaker?

Mainak Mallik, Saptarshi Bhattacharya, Suvadip Chakrabarti, Tapas Kumar Kar, Gopal Chandra Ghosh, Pritha Rakshit

Abstract :

Context: Conventionally presence of cardiac pacemakers are assigned to be relative contraindications of same sided PMMC (Pectoralis Major Myocutaneous) flap harvest due to presence of lead wires in the subcutaneous soft tissue planes, the difficulties encountered during dissection and post operative possible complications of the donor area. But under dire circumstances when the general and cardiac conditions of patients preclude all other means of higher forms of reconstruction we are left with no other choices. Aims: This study aimed at establishing if it was at all possible to perform a PMMC flap in the same side of chest wall with implanted cardiac pacemaker under dire circumstances with limited options and the patients presenting with co-morbidities which precluded options of free microvascular tissue transfer. Settings and Design: Institutional retrospective observational non-randomised purposive study over 2 months. Methods and Material: 2 PMMC flaps were done in presence of ipsilaterally placed cardiac pacemakers in 2 patients who were poor surgical candidates due to high cardiac risks after taking high risk consents and thorough counselling about the procedure details, risks and intensive post operative monitoring. Statistical analysis used: Retrospective descriptive observational study. Results: Out of the 2 PMMC flaps for oro-mandibular malignancies in 2 cases with ipsilateral chest wall cardiac pacemakers there was successful flap viability in both cases and nil donor area complications and cardiac related issues. Conclusions: Even in the presence of cardiac pacemaker PMMC flap may be harvested and used from the same side of chest wall in some patients with precautions when no other superior forms of reconstruction permit.