Thoracoabdominal Flap Closure for Large Post Pectoralis Major Myocutaneous Flap Donor Site in Advanced Oral Cancer: An Innovative Approach in Resource Constraint Setting

Oral cancer often presents in advanced stages, requiring complex surgical interventions. The bipedal pectoralis major myocutaneous (PMMC) flap is a commonly used alternative to the gold standard free flaps for reconstruction in resource-constrained settings. However, large donor sites may necessitate split-thickness skin grafting (STSG), leading to aesthetic challenges. This study explores using the thoracoabdominal flap (TA) for a large donor site closure following PMMC flap harvest in advanced oral cancer reconstruction. A retrospective analysis was conducted on twelve patients with advanced oral cancer with extensive skin involvement. The TA flap was utilised to achieve tension-free closure of the donor site. Patient demographics, clinical features, treatment stage, operative details, and postoperative complications were meticulously recorded. All patients had advanced oral cancer, with seven having left-sided disease and five having right-sided disease. The TA flap closure resulted in minimal complications, with two patients developing seromas and one experiencing marginal necrosis during the postoperative period. The innovative TA flap technique is useful in closing extensive donor sites following PMMC flap harvest for advanced oral cancer cases. It offers advantages such as improved cosmetic outcomes and fewer complications than split-thickness skin grafting.