Pectoralis Major Flap as a Reconstructive Alternative for Cervical Skin Defects Following Oncologic Parotid Surgery: A Case Report

Background: Malignant neoplasms of the parotid gland constitute an uncommon and heterogeneous group of head and neck tumors. Their management is challenging because of the gland’s close anatomical relationship with the facial nerve, major cervical vessels, and regional lymph nodes. In locally advanced tumors, oncologic resection may result in extensive cervicofacial defects that require immediate reconstruction with vascularized tissue. Case Report: A 62-year-old female patient was diagnosed with a high-grade malignant neoplasm of the left parotid gland. Computed tomography revealed a solid, irregular, hypodense lesion within the parotid space, with loss of the interface with the sternocleidomastoid muscle, coarse calcification, and cervical lymph node conglomerates. During surgical exploration, an approximately 12 × 8 cm stony-hard mass was identified, involving the facial nerve, internal jugular vein, and sternocleidomastoid muscle. A left total parotidectomy combined with a modified radical neck dissection was performed. The resection resulted in a complex cervicofacial defect measuring approximately 12 × 8 cm, with loss of cutaneous coverage and exposure of cervical structures. Immediate reconstruction was achieved using a left pectoralis major myocutaneous flap, transferred through a cervicothoracic subcutaneous tunnel. The flap provided stable coverage, well-vascularized tissue, and sufficient bulk to protect the exposed structures and partially restore the cervicofacial contour. The postoperative course demonstrated satisfactory flap integration and viability. Conclusion: The management of locally advanced high-grade parotid malignancies requires the integration of radical oncologic resection with an immediate reconstructive strategy. The pectoralis major myocutaneous flap represents a reliable, versatile, and technically reproducible option for reconstructing extensive cervicofacial defects, obliterating dead space, and protecting vital neurovascular structures, particularly when rapid reconstruction is required or microvascular free tissue transfer is not feasible.