Dumbbell-Shaped Bipaddled Pectoralis Major Myocutaneous Flap for Composite Commissural Defects: A Defect-Driven Modification

Pectoralis major myocutaneous flap (PMMF) has been a workhorse in orofacial reconstruction. Although microvascular tissue transfer has gained popularity in major tertiary centers, several infrastructural factors limit its use in many facilities, particularly in developing countries with high caseloads. Numerous modifications have been made to the PMMF since its inception. Here, we present a novel technique for reconstructing composite commissural defects with PMMF by modifying the skin paddle design to a dumbbell shape. Both ends of the paddle are used to line intraoral and extraoral defects, while the constricted middle portion recreates the commissure. We report the outcomes of a cohort of 7 patients treated at our institution, describing the modified PMMF design, harvesting, and in-setting techniques used in oral carcinoma cases involving the commissure. We have detailed the study outcomes for each patient, including the various complications related to the flap, donor, and recipient sites.