Uso do retalho osteomiocutâneo pediculado do peitoral maior na reconstrução mandibular pós-ressecção oncológica: série de caso

Abstract

The reconstruction of mandibular defects following the excision of orofacial carcinomas represents a complex challenge that requires an integrated multidisciplinary approach. This study aimed to analyze the clinical applicability, surgical technique, and outcomes of the pedicled osteomyocutaneous pectoralis major flap, highlighting the joint involvement of the Head and Neck Surgery and Oral and Maxillofacial Surgery teams. An analysis was conducted of a series of four cases involving patients with advanced neoplasms, in whom oncologic resection and reconstructive planning assisted by prototyped biomodels (3D printing) were performed. The technical differential lay in the pre-molding of the reconstruction plate on the biomodel during the preoperative period, ensuring precise maintenance of the intercondylar distance and passive rigid fixation. Immediate reconstruction was performed using the pectoralis major flap with incorporation of a rib segment. The results demonstrated the vascular robustness of the technique and the effectiveness of preoperative planning, which optimized intraoperative time and ensured an anatomical reconstruction. Postoperative complications were managed conservatively, without compromising rib-to-mandible bone union. It is concluded that collaboration between the specialties, combined with technical refinement through biomodeling, makes the pectoralis major flap a safe, predictable, and essential salvage alternative for the functional and structural rehabilitation of high-complexity patients.