Oral cavity reconstruction with pedicled and free flaps: A single institutional experience

Abstract

Background: In Indian subcontinent, oral cavity cancer is the most common cancer in males and the 4th most common in females. Seventy percent of these patients present in advanced stages and resection of these advanced cancers lead to complex orofacial defects requiring primary reconstruction to restore form, function, and cosmesis. Aim: This study aims to evaluate the results of pedicled and microvascular free flaps (MFFs) for oral cavity defects following resection of locally advanced oral cancer. Materials and Methods: A retrospective analysis of prospectively collected data of patients who underwent composite resection followed by reconstruction with pedicled or MFFs for locally advanced oral cancer from January 2018 to September 2019 was done. The demographic details, primary tumor site, tumor stage, defect type, flap type, and complication rates were analyzed. Results: Primary reconstruction was offered to 540 patients with pedicled flaps for 421 patients and MFFs for 119 patients. Patient distribution as per current Tumor, Node, and Metastasis staging was pT1/T2: 91, pT3: 179, and pT4: 270. Reconstruction offered for different oral cavity subsites was – buccal mucosa (n = 374), retromolar trigone (n = 10), alveolus (n = 75), tongue (n = 52), lower gingivobuccal sulcus (n = 11), floor of mouth (n = 4), upper gingivobuccal sulcus (n = 5), and lower lip (n = 9). We classified the types of defects into mucosal (n = 32), mucosal with bone (n = 370), mucosal with bone and skin (n = 101), mucosal with skin (n = 14), skin (n = 3), and central mandibular arch (n = 20). The overall rate of complications in pedicled flaps was 12.11% and MFFs was 20.16%. The success rate for pedicled flaps was 100% and for MFFs was 94.96%. Conclusion: In our study, MFF reconstruction had a good success rate with satisfactory functional and cosmetic outcomes.