OUTCOME ANALYSIS OF RECONSTRUCTION OF EXTENSIVE DEFECTS FOR LOCALLY ADVANCED HEAD AND NECK MALIGNANCY dixitpk@aiimsjodhpur.edu.in

 

OUTCOME ANALYSIS OF RECONSTRUCTION OF EXTENSIVE DEFECTS FOR LOCALLY ADVANCED HEAD AND NECK MALIGNANCY

1

India

Oral or Poster

Tissue requirements after resection of locally advanced head and neck malignancy are immense. Various combinations of free tissue reconstructions have been described. Present study evaluates the outcome of microsurgical reconstruction for extensive defects in locally advanced head and neck malignancy.

Patients with T4 disease with extensive soft tissue defects were included in the study. Patients factors and comorbidities, TNM staging of disease, intra and extra oral defect size, choice of flap, and flap size was recorded. Post-operative flap survival and complications were recorded. Radiation delay if any, recurrence of disease, speech and oral diet resumption were also assessed.

177 patients of head and neck malignancy with T4 disease were included. Most common reconstruction was free anterolateral thigh (ALT) flap with reconstruction plate (114) followed by free fibula with deltopectoral flap (47). Double free flaps (free fibula with free ALT flap) were performed in 16 patients. 16 patients were re-explored out of which 10 flaps were salvaged. Plate exposure and orocutaneous fistula rates were high in ALT with plate group along with poorer speech outcome. Radiation delay due to wound related complications were observed in 8% of patients. Loco-regional recurrence of disease was found in 30 %.

Simultaneous two free flaps (free fibula and ALT) provides better form and function with lesser complications in locally advanced head and neck disease followed by combination of free osteocutaneous and pedicled soft tissue flap.