OP163: Optimal application of reconstructive microsurgery in a high volume tertiary referral cancer centre

Abstract

Background Although the state of art free flap reconstruction of oral defects is not cost effective in a high volume low resource set up with scarcity of trained hands. Patients and methods Thirty-five consecutive cases of oncologic head and neck micro vascular reconstructions at the Regional Cancer Centre, Trivandrum, between October 2004 and October 2011 were studied prospectively for the flap viability, cosmesis, function (speech and swallowing) and locoregional recurrence. Free flap reconstruction was planned in all these cases either because it was the only available option or because it was far superior to the conventional option. Results There were 25 males and 10 female patients, the ages of whom ranged from 16 to 75 years with a mean ±S.D of 46 ± 14 years. Twenty-five cases were squamous cell carcinomas, two were soft tissue sarcomas, one was an intraosseous carcinoma one was a chondrosarcoma two were osteosarcomas three cases were recurrent ameloblastomas and one was a recurrent basal cell carcinoma. Site distribution and the flap chosen for reconstruction and the type of neck dissections done were as follows. (See Table 1 .) Free fibular flap showed the highest success rate (100%) followed by radial forearm (77%) and ALT (50%). The follow up period ranged from 2 to 59 months with a mean of 19.6 months and median of 14 months. The operating time ranged from 255 to 495 min with a mean 398 ±SD of ±52 min. Twenty-nine cases were uneventful and 6 flaps failed. None of these patients required prophylactic tracheostomy and only one of the failures required a second flap. Six patients either recurred locoregionally or had metachronous second primary. (See Table 2 .) Conclusion Adequate training and optimal application are the key factors determining success in micro vascular reconstructive surgery in a low resource high volume cancer centre.