Aim: The aim of the study is to evaluate the feasibility and effectiveness of the Folded Pectoralis major myocutaneous flap (PMMC) flap with tram track de–epithelization in the patients with advanced oral malignancy requiring full thickness cheek excision.

Material and methods: This was a prospective study undertaken on patient of full thickness cheek tissue defect (having both skin and mucosal defect) after resection of the tumor. A total of 24 patients was included. After resection, the resultant defect was covered with folded pectoralis major myocutaneous flap with tram track de–epithelization. The patients were grouped separately depending on the site of defect reconstructed pertaining to the oral cancer. The site of the defect reconstructed, the size of the flap harvested and outcome were analyzed in detail.

Results: Flap survived in all the patients and we were able to cover even large defects involving full thickness of cheek simultaneously. In one patient who had recurrence following resection, the reconstruction during first operation was with ipsilateral folded pectoralis major myocutaneous flap and subsequent reconstruction after surgery for recurrence was with contralateral flap using the same technique. None required flap revision and all complications were managed conservatively.

Conclusion: Folded pectoralis major myocutaneous flap with tram track de epithelization has proved itself as a workhorse for the full thickness reconstruction and is obviously superior to double flaps such as a combination of pectoralis major myocutaneous with deltopectral flap which require two stage procedure.