Background: Reconstruction following head and neck cancer surgery remains a major challenge. Although microvascular free flaps are considered the gold standard, resource limitations and technical expertise often make pedicled flaps, particularly the pectoralis major myocutaneous (PMMC) flap, the preferred option in many centers.

Objective: This study aimed to evaluate the outcomes, complications, and reliability of PMMC flap reconstruction in patients with head and neck cancers.

Methods: A prospective observational study was conducted at a tertiary care teaching hospital. Fifty patients with advanced head and neck malignancies requiring composite resections underwent reconstruction using PMMC flap. Patient demographics, tumor characteristics, surgical details, and postoperative outcomes were analyzed.

Results: Among 50 patients (36 males, 14 females; mean age: 54.3 years), oral cavity cancers were most common (72%), followed by oropharyngeal (14%), hypopharyngeal (8%), and laryngeal tumors (6%). PMMC flap was used for mucosal defect coverage in 40 patients, cutaneous coverage in 6, and combined defects in 4 patients. Flap-related complications occurred in 14 patients (28%), including minor partial necrosis (8%), major partial necrosis (4%), wound dehiscence (10%), and fistula formation (6%). No total flap loss was observed. Non-flap-related complications included hematoma (6%) and surgical site infection (12%).

Conclusion: PMMC flap remains a reliable and versatile reconstructive option in head and neck cancer surgery, particularly in resource-limited settings. Despite a moderate complication rate, flap survival was excellent, supporting its continued role as a workhorse flap in head and neck reconstruction.