Indications for a PMMF reconstruction

Indications for a PMMF rather than a free flap reconstruction as the first choice in our department in the study period from June 2007 to date included two categories: salvage or emergency procedure and primary reconstruction. Salvage PMMF reconstruction was considered in the following circumstances: (1) Failure of a free flap that needed another flap for closure of the wound; (2) Major complications such as fistula that was incurable without a surgical flap; (3) Protection of the Carotid artery in cases of carotid rupture for patients who underwent emergency vascular repair. Primary reconstruction with PMMF was considered when: (1) patients could not tolerate prolonged operation, mainly due to high ASA grade (3 and 4) and/or age older than 75 years with poor general status; (2) existence of potential high risk factors for free flap reconstruction, including long-term poorly controlled diabetes, systemic vascular sclerosis, and previous intensive radiotherapy (dose >60 Gy) to the neck; (3) patients with vessel depleted neck due to previous surgery; (4) coverage of the carotid artery to prevent accidental rupture in high risk patients, e.g. cervical metastasis with involvement of the overlying skin; (5) reconstruction for total glossectomy defects.