INITIAL EXPERIENCE OF RECONSTRUCTION OF SURGICAL DEFECT IN HEAD AND NECK WITH FREE FLAP AT DEDICATED CANCER CENTER IN NEPAL

Abstract

Background:
Due to the complexity of surgery, fear of flap failure and lack of resources, free flap reconstruction is rarely performed at most centers in Nepal. Recently free flap reconstruction following ablative surgery for head and neck cancer has been started at Kathmandu cancer center. This study aims to determine the short-term outcomes and success rates of free flap reconstruction following ablative surgery for head and neck cancer at Kathmandu Cancer Center.
Materials and methods:
This is a retrospective chart review of all patients who required free flap reconstruction following head and neck surgery for cancer from July 2021 to December 2022. Various characteristics of patients and details of treatment were extracted from the records.
Results:
During the study period, 38 patients with a median age of 50 underwent surgery for head and neck cancer and required reconstruction with free flap. Primary cancer was the indication for surgery in 32 patients whereas one had undergone surgery for residual tumor and five had undergone surgery for recurrence or second primary. Free radial artery forearm flap (FRAFF) was utilized in 20 patients, free anterolateral thigh flap (FALTF) in 11 patients and free fibula osteocutaneous flap (FFOCF) in 7 patients.  Median duration of surgery was 540 minutes. Reexploration within 24 hours was required for two patients, one for hematoma and other for ischemia. One patient experienced free flap failure due to arterial ischemia, resulting in an overall success rate of 97%.
Conclusion:
Dedicated, skilled teams can achieve comparable success and acceptable short-term outcomes in free flap reconstruction.
Keywords: Anastomosis, FALTF, FFOCF, FRAFF, ischemia, oral cavity, neck dissection, Squamous cell cancer.