Abstract
BackgroundIn Canada, 4,400 cases of oral cancer are diagnosed yearly. Surgical resection is a key component of treatment in many of these cancers. Reconstruction of defects, with the goal of preserving function, is of utmost importance. Several choices are possible for reconstruction of larger defects, including both free and pedicled flaps. Free flap reconstruction is reliable and effective, but requires additional personnel and peri-operative resources. Pedicled flaps remain an important alternative to free flaps, and are less resource intensive. This paper reviews our inaugural experience with the submental island flap (SIF) and compares costs incurred to a matched cohort of oral cancer patients reconstructed with forearm free flaps.MethodsCharts of patients who underwent SIF and RFFF reconstruction from January 1st 2013 to April 1st 2015 were retrospectively examined. Associated costs were obtained via online database and previously reported costs at the study institution.ResultsMean length of ICU stay in glossectomy RFFF reconstruction was 4.7 days. Only one patient required ICU stay for one night in the SIF group. Mean length of hospital stay was not significantly different in SIF patients vs RFFF patients (12.4 vs 15.4 days, p > 0.05). Mean operative time was significantly lower in the SIF group compared to the RFFF group (347 vs 552 min, p < 0.05). Total mean intraoperative costs were found to be $4780.59 for RFFF operations, versus $2307.94 for SIF. Total mean cost of post-operative stay was $18158.40 in the SIF group and $43617.60 in the RFFF group. Total cost savings were therefore $27931.85 per patient for the SIF group.ConclusionsWe have demonstrated the use of the submental island flap as an alternative to radial forearm free flaps, showing both decreased hospital costs and comparable patient outcomes. Pedicled flaps are making a resurgence in head and neck reconstruction, and the submental island flap offers an excellent alternative to more labour intensive and costly free flap alternatives.
Highlights
In Canada, 4,400 cases of oral cancer are diagnosed yearly
Submental island flap reconstruction series patient demographics A total of 12 patients were identified within the study period that were scheduled for submental island flap reconstruction
Mean operative time was significantly lower in the submental island flap (SIF) group compared to the radial forearm free flap (RFFF) group (347 vs 552 min, p < 0.05, Fig. 3)
Summary
In Canada, 4,400 cases of oral cancer are diagnosed yearly. In Canada, 4400 new cases of oral cancer are diagnosed yearly [3]. Surgical resection is typically a key component of treatment in most cancers originating in the oral cavity, pharynx, face, or neck [4]. Free tissue transfer has become a mainstay of reconstruction in recent years, offering improved vascularity and wound healing, potential for innervation, tailoring of the wound defect, and a wide variety of tissue options [5]. These flaps have become the standard against which other means of reconstruction must be evaluated
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