Free-flap reconstitutions of head and neck defects after oncologic ablation

Abstract

Background: Head and neck cancers are the sixth most common cancers worldwide. The primary treatment modality for most head and neck cancers is surgery with reconstruction of resultant defects. Reconstruction of these defects is a unique challenge as it has to not only restore integrity but also function and often cosmesis. The objective of this study was to assess the utility of free flaps in the reconstruction of these defects, done in a tertiary care centre in a three-tier city in India. Methodology: We analyzed the computerized medical records of the last 3 years in this retrospective study carried out in the department of head and neck oncology at the cancer centre. The study included cases that had undergone surgery for head and neck cancer and underwent free flap reconstruction. Results: Out of the 1061 cases requiring reconstruction after an oncologic ablation, 201 cases underwent free flap reconstruction. For defects requiring Facio cutaneous reconstruction, the radial forearm was the preferred donor free flap site, while the fibula was the preferred donor site for mandibular reconstructions survival rate was 94.5%, with factors like age and comorbidities like diabetes and hypertension or habits like cigarette smoking or tobacco
chewing not affecting survival rates. Twenty cases of minor flap complications were observed. Conclusions: Free flap reconstructions for head and neck defects after oncologic ablation have been a boon with good survival rates and
immense flexibility of use, giving good cosmetic and functional outcomes. Our study shows that a significant number of free flap reconstructions can be done in a tertiary care centre in a three-tier city in India with an internationally comparable survival rate.