Journal of Head & Neck Physicians and Surgeons (Jan 2019)
Analysis of first week complications of microvascular free flap reconstructions after oral cavity cancer resection: A Single Institutional Experience of 314 Cases
Abstract
Introduction: There has been an increase in patients seeking treatment for oral cancers. Good and reliable reconstruction methods are needed to provide good cosmesis in early stage cancers and to fulfill large tissue requirement after complex head and neck resections in advanced stage cancers. Microvascular free flaps exactly fit into the needed framework. However, free flaps also have their limitations and complications. Materials and Methods: Data of all patients who had oral cancer resections and reconstructions performed at HCG Cancer Centre, Vadodara from May 1, 2016, to December 31, 2018, were reviewed. Out of them, patients in whom free flaps were done were included in the study. Ethical approval for this study was not needed as it was on a retrospective basis. Postoperative monitoring of the flap was done mainly by clinical observation and pinprick test. Color Doppler ultrasound was done to detect flow in arterial failure cases. Observation and Results: Our complication rate was 6.68% out of which flap salvage rate was 23.8%. Hence, it is very important to pick up early signs of developing complications to increase the flap salvage rate. Discussion: Better wound healing, cosmesis, better functional – social – psychological rehabilitations are the prime advantages of various free flaps. Events occurring in the 1st week have maximum influence on the free flap viability. During the 1st postoperative week, vigilant lookout should be there for signs and symptoms to detect early flap-related complications so that timely interventions can be taken to salvage them. No flap complication in the 1st week is a good prognostic indicator for flap survival and thus preventing any delays in further adjuvant treatment. Conclusion: No flap complication in the 1st week is a good prognostic indicator for flap survival and thus preventing any delays in further adjuvant treatment.
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