Title: Free Flap versus Pedicled Flap Reconstruction for Oral Cavity Malignancies: Treatment algorithm based on our experience with 37 cases in our institute
Authors: Sagar Gundewar, Al-Iqyan Fidvi, Richa Goyal, Manoj Pawar, Parmeshwar Satpathy
DOI: https://dx.doi.org/10.18535/jmscr/v4i12.10
Abstract
Introduction- The reconstruction of defects after excision of oral malignancy is a challenge. The armamentarium of a reconstructive surgeon includes a plethora of flaps such as microvascular free flaps and regional or local pedicled flaps. The patients in our institution require a holistic approach towards not only reconstruction of the defect but also towards improving their nutritional status within the limits of their socio-economic background.
Methods: We conducted an epidemiological study of patients with oral malignancy in our institute over a period of 3 years. Thirty seven patients were studied during their course of management from pre-operative preparation to post-operative follow up. The choice of flap used for reconstruction depended on location and volume of defect, seropositive status and ejection fraction of the patients.
Results:- Of the 37 patients studied, there were 28 males and 7 females, with an average age of 49 years. The most common site of involvement was the buccal mucosa (43%) and most common histopathological type was squamous cell carcinoma (96%). Microvascular free flaps were used for reconstruction in 72% of patients and pedicled flaps were used in the remainder. Major complications which occurred with microvascular free flaps were hematoma formation with compromised flap circulation (4 cases), complete flap loss (2 cases), and venous congestion requiring intervention of the flap due to venous thrombosis. No major complications were reported with the pedicled flaps. Other complications included partial flap necrosis, oro-cutaneous fistula formation, wound infection, skin graft loss at the donor site. No significant relation was found between age, body mass index type of flap and the rate of occurrence of complications.
Conclusion:- As compared to pedicled flaps free flaps have superior outcomes in terms of functional rehabilitation and aesthetic appearance. Factors such as old age and low nutritional status do not preclude the use of free tissue transfer in reconstruction. In our opinion factors such as low ejection fraction and sero-positive status are better managed with pedicled flaps.
Keywords:- Oral Carcinomas, Free flaps, Pedicled Flaps, Age, Body mass index, Echocardiography.
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