Orocutaneous Fistula Research Articles

Reconstruction of Complex Oral and Maxillofacial Defects After Oral Cancer Resection With Individualized Anterolateral Thigh Multiple Paddle Flaps.

This study aimed to use reconstructive methods for complex oral and maxillofacial defects, explore their feasibility, and evaluate the efficacy of defect reconstruction using anterolateral thigh (ALT) multiple paddle flaps. The authors performed a retrospective case series of 33 patients who underwent oral and maxillofacial defect reconstruction using the ALT multiple paddle flaps. The design and harvest of the flaps, methods for defects reconstruction, and reconstructive efficacy are described. All 33 patients were men, with a mean age of 49.5 years. Of the flaps, triple skin paddles plus muscle paddles were included in 3 cases, triple skin paddles were included in 1 case, 2 skin paddles plus muscle paddles were included in 29 cases. The skin paddles measured 3×5cm to 10×16cm. Postoperatively, all flaps survived completely. Parotid salivary fistula and orocutaneous fistula occurred in 1 patient of each, thigh wound infection and effusion occurred in 1 and 2 patients, respectively. All patients were followed up for ~2 to 93 months; most patients' oral functions and appearance were acceptable, and thigh motor dysfunction was not observed. With separate skin paddles for defects of different positions, individualized muscle flap for dead spaces, combination of different skin paddles for larger defects, effective reduction or avoidance of wound complications, and acceptable donor site morbidity, the ALT multiple paddle flaps are an ideal candidate for complex oral and maxillofacial defects reconstruction.

Free Latissimus Dorsi Flaps in Head and Neck Reconstruction at a Modern High-Volume Microsurgery Center.

Over the past two decades, with the introduction of the perforator flap concept and advances in flap dissections, lower extremities have emerged as the preferred soft tissue flap donor sites. As a modern and high-volume microsurgical center, and the senior author being one of the pioneers and advocates for the use of lower extremity flap donor sites, we aim to investigate the role of latissimus dorsi (LD) free flap in head and neck reconstruction within our current practice. All free LD flaps used for head and neck reconstruction performed by a single surgeon between January 2010 and June 2023 were reviewed for their indications and immediate and short-term outcomes. A total of 1,586 head and neck free flap reconstructions were performed, and 33 free LD flaps were identified. The patients' median age was 53 (interquartile range [IQR] 48.5-63.5) years. Twenty-nine (87.9%) flaps were used to reconstruct oro-maxillo-facial and four (12.1%) flaps were used to reconstruct scalp defects. Most patients had prior radiation (n = 28, 84.8%), neck dissection (n = 24, 72.7%), and multiple previous head and neck flap reconstructions with a median of 3.0 (IQR 3.0-3.5) previous flaps. Six (18.2%) LD flaps were used to replace failed flaps from other donor sites. No major complications such as total flap failure or takebacks, and no need for vein grafts but three (9.1%) had flap marginal necrosis. Other complications included one flap dehiscence (3.0%), one orocutaneous fistula (3.0%), two wound infections (6.1%), three plate exposures (9.1%), and three patients who developed local recurrence (9.1%). The median patient follow-up time was 16 (IQR 5-27) months. This retrospective study demonstrates the role of LD free flap in head and neck reconstruction as a reliable and versatile backup soft tissue flap when workhorse flaps from lower extremity donor sites are either unavailable or unsuitable.

Full-thickness nasolabial facial artery flap: A modified surgical approach for reconstruction of lower lip defects.

Reconstruction of large lower lip defects remains challenging in terms of aesthetics, function and safety. The aim of this study is to explore a modified nasolabial flap to repair large lower lip defects. The full-thickness nasolabial facial artery flap was used for reconstruction of defects in lip squamous cell carcinoma (LSCC) patients after tumor ablation. The postoperative recovery of patients was obtained through clinical review and follow-up in the first and sixth month. There were four LSCC patients who received tumor ablation at the Beijing Stomatological Hospital of Capital Medical University from November 2022 to March 2023, were included in our study. All patients did not suffer from postoperative infection, orocutaneous fistula, flap necrosis, and flap loss. One patient had the trapdoor deformity. These patients achieved better lip closure function. One patient developed cervical lymph node metastasis 2 months after surgery. The modified nasolabial flap could achieve good outcomes in terms of aesthetics, function, and safety. It provided a supplementary strategy for the using of nasolabial flap in larger defects of lower lip.

Reconstruction of Composite Mandible Defects Using a Cellular Bone Allograft and Soft Tissue Free Flap Coverage

Study Design Retrospective case series. Objective Cellular bone allografts (CBAs) contain the components of a successful bone graft with no autologous component and have been used extensively outside the head and neck. Descriptions of their utilization for mandible reconstruction are limited. We review our experience utilizing a CBA, with no autologous component, for the reconstruction of mandible defects. Methods Patients undergoing reconstruction of a composite mandible defect with a CBA, no added autologous component, within a patient-specific graft cage and soft tissue free flap coverage were retrospectively identified. Graft survival and defect management are assessed and results of post-operative imaging reported. Results Five subjects, aged 23–56 years, underwent reconstruction of mandible defects with the described technique. Defects resulted from gunshot wounds in 4 patients and the composite resection of a low-grade malignancy in one. The defect was definitively managed in 4 subjects, 3 of which had post-operative imaging demonstrating bone formation. The fifth experienced graft failure after developing an orocutaneous fistula and was successful salvaged with an osteocutaneous fibula free flap. Conclusions Our early experience is promising that a CBA, with no autologous component, and soft tissue free flap coverage can be used for the reconstruction of composite mandible defects in select patients.

Early feeding after free flap reconstruction of the oral cavity: A systematic review and meta-analysis.

Traditionally, patients undergoing free flap reconstruction for oral cavity defects have been given nothing by mouth for 6-14 days post-operatively due to concern for orocutaneous fistula development. Multiple databases were screened for studies assessing the rate of orocutaneous fistula formation in early (≤5 days) versus late (>5 days) feeding groups following oral cavity free flap reconstruction. Fixed- and random-effects meta-analyses were used. One randomized controlled trial, one prospective cohort, and three retrospective cohort studies were included. The early feeding group displayed no significant increase in orocutaneous fistula formation (RD = -0.02, p = 0.06) or free flap failure (RD = -0.01, p = 0.39), with a significantly shorter hospital length of stay (mean difference [days] = -2.43, p < 0.01). While further prospective trials are necessary, initiation of oral intake before post-operative day 5 may be appropriate in properly selected patients following oral reconstruction.

Infrahyoid Myocutaneous Flap for Reconstruction in Head and Neck Cancer Patients

Objective: Oral cancers are one of the most common cancers in India. Tongue and lower gingiva-buccal sulcus are the most common subsites in oral cancers. Good reconstruction after resection of primary is a demanding task and determines quality of life. This study reviews our experience with infrahyoid flap (IHF) in reconstruction of small and medium sized defects after oral cancer resection. Materials and Methods: This study retrospectively analyzes all patients of oral cavity squamous cell carcinoma who underwent IHF flap by a single surgeon from July 2018 till June 2022 with a median follow‑up of 12 months. Results were analyzed based on characteristics of the patients, site and size of defect, postoperative complications and clinical outcome. Results: Out of 14 patients, 4 patients had skin paddle necrosis (2 total and 2 partial). None of the patient suffered a total flap loss. All cases of partial flap loss resolved with conservative treatment and none of the patient required a revision surgery or developed orocutaneous fistula. The largest flap size was 9 × 4.5 cm. Conclusion: The infrahyoid myocutaneous flap is a fairly reliable and easy to perform flap for small and medium‑sized defects of the oral cavity.

Complications of Reconstructive Surgery in Head and Neck Region: A Cross-Sectional Study from Bangladesh

Background Microvascular free flaps are ideal for reconstructing post-oncological surgery defects in the head and neck region. Free flaps provide ample tissue for reconstructing even large, complex defects, which gives oncosurgeons flexibility during tumor resections. Methods We performed 50 free flap head and neck reconstructions in 978 patients from June 2015 to September 2018. For reconstructing bone defects, our flap of choice was the free fibula. The surgical outcomes and complications according to flap were retrospectively reviewed and analyzed. Results The overall flap success rate was 98.1%. A total of 45 cases required emergency surgical re-exploration for compromised flaps and 19 of these flaps could not be salvaged. Venous insufficiency was the most common cause of surgical re-exploration. Flaps with delayed arterial thrombosis and vascular compression could not be salvaged. Other complications were partial flap necrosis, oro-cutaneous fistula, and donor site complications. No statistically significant differences were noted for complications in elderly and post-radiotherapy patients. Conclusions Free flap reconstruction is a robust and highly reliable option for head and neck defects and free flaps are a safe option for treating large defects. A second free flap should be the first choice in failed cases after the medical optimization of the patient. Free flap reconstruction is safe in elderly and post-radiotherapy patients.

Virtual Surgical Planning Facilitates Surgical Resection in Mandibular Osteoradionecrosis and Optimize Reconstructive Outcomes

Background: Mandibular osteoradionecrosis (ORN) is a devastating complication of radiotherapy for oropharyngeal malignancy. Despite advancements in ORN treatment, risk of ORN recurrence remains high following surgical resection. Virtual surgical planning (VSP) for ORN treatment is an evolving application that may not only inform bony reconstruction but also therapeutic surgical margins, which remain inconclusively defined in the literature. Methods: A retrospective review was performed of 25 cases in which patients underwent VSP-guided resection of mandibular ORN followed by immediate free fibula flap reconstruction. Surgical margins of 1-cm from radiologically evident disease were taken. VSP accuracy was quantified by comparing measured anatomic parameters between the virtually planned outcomes and the final outcomes on postoperative imaging. Statistical analyses were performed to assess associations between preoperative factors and postoperative complications including ORN recurrence. Results: The mandibular body was most frequently affected by ORN in this series of patients. Among risk factors, only the presence of a preoperative orocutaneous fistula was predictive of a complication, specifically partial flap failure (β = 1.41; P = .013). Intended anatomic parameters were achieved with the exception of the intergonial distance (x difference = 0.53 cm; P = .03). Finally, there were no cases of ORN recurrence after a mean follow-up of 27.4 months. Conclusions: VSP of free fibula flaps for mandibular reconstruction following ORN is a valid tool for effecting accurate anatomical outcomes. Furthermore, we demonstrate that a 1-cm margin around radiographically evident ORN may effectively implement a curative outcome free from relapse.

Distribution of Misdiagnostic Maxillofacial Nonmalignant Lesions and Conditions in Salah Alden Government

Diagnosis is the corner stone &amp; entry to the treatment of lesions or conditions. Because misdiagnosis leads to incorrect treatment. It is very important to understand the distribution between the most common misdiagnosis nonmalignant lesions&amp; conditions in the maxillofacial region as apart of whole misdiagnosis. Decrease patient complaining. Evaluate the most common misdiagnosis lesions&amp; conditions in maxillofacial region. Decrease load to hospitals&amp; clinics&amp; decrease infections. The data collected by standardized formula for all patients&amp; different patient clinical, radiological examination &amp; methods used to confirm the diagnosis. Total no. are 30 patients, misdiagnosis lesions&amp; conditions 13% (Sinusitis or dental pain), 20% (submandibular Lymphadenitis. or Sialadenitis), 20% (Otalgia). 10%(Psychopath),10%(Trigeminal neuralgia) ,7%(migraine) ,7%( maxillary sinusitis),13%(submandibular saialidinitis). the true diagnosis was 13%,( Oroantral fistula),20%(oro-Cutaneous fistula),20%(Tmj pain),10%(Tmj dislocation),10%(dental pain),7%(dental pain),7%(Maxillary sinus cyst),13%(submandibular Salivary gland stone). The more unorganized medical &amp;or surgical branches interference within region may lead to these misdiagnosis results. Poor educated patients, doctor’s decision with inadequate examination&amp; investigation participate in increase patients complaining

Submental Artery Island Flaps (SAIF) for Oral Cavity Cancer: Surgical Technique and Tertiary Care Experience.

In oral cancer surgeries, oncological outcomes take precious driverseat. But the copassengers like reconstruction, cosmesis, swallowing and speech outcomes deserve equivalent importance. Submental Artery Island Flaps (SAIF) provide an underutilized and extremely versatile option for reconstruction of defects following early stage oral cavity tumour resections. In this prospective observational analysis, we describe the technique, challenges and outcomes of SAIF at our tertiary care institute. Sixteen patients with Stage I and II oral cavity cancers were enrolled between June 2020 to May 2021. Verrucous carcinomas were five and well differentiated carcinomas were 11 patients. After tumour excision and neck dissections, defects were reconstructed with Pedicled submental flaps. Complications and functional outcomes were analyzed over two years. Nineteen percent were ladies and 81% were gentlemen. Median age was 52years. Tongue tumours formed majority with 56% cases. Largest skin paddle taken was 36cm2. Flap survival was 88%. There were variations in venous drainage of flaps which have been depicted in case figures. There was no report of orocutaneous fistula. Grade 3-4 speech satisfaction was achieved by 81.2% patients at 6months. Swallowing was excellent, grade 4-5 for 100% of patients at 6months. One patient had distant metastasis at 7months and died. SRLR (Submental flap Recurrences) and trismus were zero percent at two years. The unexplored field of submental flaps can be used for oral cancer reconstructions in a versatile way. Donor site easy closures, no scars on face, early resumption of daily activities and short hospital stay makes it one of the ideal options in early stage oral cavity defects.

Infrahyoid flap—a good substitute for free flaps in oral reconstruction during the COVID‐19 pandemic

AbstractAimDuring the coronavirus disease 2019 (COVID‐19) pandemic, experts have recommended simplifying the process of reconstruction following the extirpation of head and neck cancer by favouring the use of pedicled flaps over free flaps. This approach reduces the duration of the operation and mitigates the risk of free flap failure, which can be exacerbated by the hypercoagulopathy state seen in infected patients. We aim to contribute our experience with the pedicled infrahyoid flap, a procedure not previously reported in Hong Kong.Patients and MethodsWe conducted a retrospective study including patients who underwent infrahyoid flap reconstruction following resection of oral cavity cancer. Data for a total of nine patients were retrospectively retrieved from the hospital's computerised systems, and these patients were evaluated for demographic information, clinicopathologic parameters as well as oral function and reconstruction outcomes.ResultsAmong the nine infrahyoid flaps used, eight were myocutaneous flaps and one was a muscle flap. The dimensions of the flap skin ranged from 24.0 to 46.72 cm2. All of the flaps, with the exception of one case that experienced epidermolysis of the flap skin, exhibited complete survival. Fortunately, the epidermolysis healed without complications, such as the development of an orocutaneous fistula. The average time required for flap harvesting was approximately 1 hour. All nine patients were able to resume oral feeding and achieved satisfactory speech outcomes. Seven of these patients survived without any tumour recurrence, but unfortunately, two patients died due to lung metastases.ConclusionsThe infrahyoid flap proves to be a viable alternative to free flaps for the repair of medium‐sized oral defects, especially in compromised patients and during the COVID‐19 pandemic.

Anchored sutures for fixation of the anterolateral thigh flap and prevention of orocutaneous fistula in oral and oropharyngeal cancer reconstruction.

This study aims to assess the efficacy of anchored sutures (AS) in securing the anterolateral thigh (ALT) flap during oral and oropharyngeal reconstructions, and its impact on the occurrence of orocutaneous fistula (OCF). A retrospective study was performed on patients who underwent ALT flap reconstruction in our department in the year 2022. The patients were divided into two groups based on whether the AS technique was used. The incidence of OCF was compared between the two groups, and AS-related complications were reported. Fisher's exact test was employed to assess the differences in baseline characteristics and the incidence of OCF between the two groups. The study included 214 patients, with 156 in the conventional suture (CS) group and 58 in the AS group. The incidence of OCF in the AS group was significantly lower compared to that in the CS group (P = 0.039). However, there was a weak correlation between OCF and the AS technique (φ = -0.149). Among the 58 cases in the AS group, three (5.17%) experienced AS-related granuloma (ASRG) as complications. The use of ALT flap reconstruction with the AS technique reduces the incidence of OCF; however, ASRG may be a potential complication. This study demonstrates the effectiveness of AS technique in securing ALT flaps, leading to a decreased risk of OCF in oral and oropharyngeal defect reconstruction.

Prosthetic Management of Flap-Related Complications Following Glossectomy in Locally Advanced Tongue Cancer.

Total glossectomy defects resulting from postoncologic resection are commonly reconstructed with locoregional or free flaps. However, effectively managing complications that may arise after reconstruction can be a significant challenge. We present a unique case series describing prosthetic management of flap-related complications following glossectomy in patients treated for locally advanced tongue cancer. Three patients underwent total glossectomy, neck dissection, reconstruction using free flap, and tracheostomy. Two patients developed an intraoral fistula located in the anterior region of the floor of the mouth. The third patient developed a flap failure requiring a second procedure using a pectoralis major myocutaneous flap for correction of the orocutaneous fistula that ultimately did not heal. Mandibular obturator prostheses lined with a soft liner were fabricated for all the patients, which helped reduce salivary incontinence and improve swallowing and speech. This case series highlights that a collaborative interdisciplinary team approach is crucial for optimizing postoperative function and outcomes when managing complications from reconstructive procedures.

The Dental Oncology Complication that Wouldn’t go Away

Background: Bone modifying agents are used throughout cancer care and their utilisation can optimise advanced stage cancer cases with bone metastases, by reducing skeletal-related events, treatment-induced bone loss and treatment hypercalcaemia. They are also used in patients with a curative intent such as early breast cancer, reducing recurrence and increasing survival rates. Medication-related osteonecrosis of the jaw (MRONJ) is a potential complication following bone modifying agents (BMAs). It represents exposed bone in the maxillofacial region which significantly compromises the quality of life for these patients. Dental disease is the most common initiating factor of MRONJ. We report a case in which MRONJ has dominated cancer care despite its successful treatment. Case presentation: A 69-year-old female was diagnosed with a breast cancer (grade 1, infiltrating ductal carcinoma, pT1c pN1mi(sc) Mx), for which she was treated with a wide local excision and axillary lymph-node clearance. Seven years after initial presentation, the patient presented with metastatic disease involving the left supraclavicular fossa, bone, peritoneum, and liver. Her BMA regime included zoledronic acid intravenous (IV) every month for 12 months and switched to oral zoledronic acid for a subsequent year due to poor venous access. Two years after her diagnosis of metastatic disease, the patient presented with exposed bone in her anterior maxilla, which represented advanced stage MRONJ (AAOMS 3). The exposed bone in the maxilla was treated surgically by sequestrectomy and fistula closure. Three years later (12 years after initial breast cancer diagnosis), the patient was re-admitted with a cervical fascial space infection involving the right mandible. The patient developed another site of advanced- stage MRONJ (AAOMS 3) in the right mandible associated with an orocutaneous fistula. The patient had a marginal resection of her mandible, fistula closure and extraction of the remaining teeth under general anesthetic. Conclusion: The practicing oncologist needs to be cognisant of the possibility of MRONJ in both the curative and palliative setting. Traditionally, oncology care has required a significant degree of self-reliance on patients to navigate dental treatment pathways. Integration of dental clinics into oncology pathways would help eliminate this need for self-reliance. MRONJ is an inevitable risk for a large cohort of oncology patients and active engagement of dental-oncology specialities will ensure optimal care for patients.

A Proposal for Orocutaneous Fistula Grading Following Oral Cancer Surgery

A Proposal for Orocutaneous Fistula Grading Following Oral Cancer Surgery

Start of the Seventh Volume in 2023 and Analysis of Publishing Achievements of 2022

Starting the 7th volume of the Journal of Diagnostics and Treatment of Oral and Maxillofacial Pathology we are becoming stronger, more mature, and resilient. Even though the Journal has been published for essentially 11 months of 2022 of large-scale war of Russia against Ukraine and Europe, the editorial and publishing staff demonstrated the ability to withstand the impact of war and continue to publish peer-reviewed achievements. In total, 32 articles were published in the volume 6. Among which, 10 articles were devoted to wartime challenges and gunshot wounds. Two papers presented cutting-edge microvascular and prosthetic techniques. Massarelli and Meloni reported a unique technique in a paper titled The “beveled one-and-a-half-barrel” fibula transplant with virtual surgical planning and CT-guided implant surgery for prosthetic rehabilitation in posterior mandible defects: a pictorial essay. Le and colleagues manufactured an exclusive tongue prosthesis which was well-described in an article titled Patient-specific prosthetic appliance for interim management of chronic orocutaneous fistula in the irradiated and vessel-depleted head and neck patient – a case report and technical note. Geographical distribution of authors in 2022 included five countries—Italy, Slovak Republic, Qatar, Ukraine, and United States of America (USA). The first quarter of year 2022 was also marked by the establishment of the resident ambassador position and the appointment of John M. Le, DDS, MD, as a real leader, to this founding position. Also, we were honored to see Michael T. Kase, DMD, a true expert in maxillofacial prosthetics as a new board member who can bring a lot of expertise to the Journal in this growing direction.6 Thus, by the end of 2022, the Journal’s editorial board has grown to 30 experts, enhancing Journal’s international vision and approaches.

Closure of Orocutaneous Fistula with a Tongue Flap: A Case Report

Closure of Orocutaneous Fistula with a Tongue Flap: A Case Report

Experience in Oral Cancer Reconstruction in a Tertiary Care Center of Nepal

Introduction: Oral cancer is one of the most common malignancies in Nepal. Most patients have locally advanced disease during their initial presentation, necessitating substantial resection and leaving significant deformity. Functional and anatomical restoration of these defects is crucial. This study analyzed the clinical presentation of oral cancer, surgical management, and encountered complications in the Nepalese context. Methods: This was a single-center retrospective study of oral cancer reconstruction performed at Tribhuvan University Teaching Hospital, Kathmandu over four years period (September 2018 - September 2022). Demographics, clinical presentation, comorbidities, treatment, and complications were recorded and analyzed. Results: Out of the analysis of 36 cases of oral cancer, most of the patients were in the fifth decade of life with male to female ratio of 3:1. The most common primary site involved was buccal mucosa (38.88%). Twenty-two cases (61.11%) were in the locally advanced stage. Tobacco chewing was a common entity in personal habits. Surgery consisted of eighteen pedicled, sixteen free flaps, and five local flaps. Pectoralis major myocutaneous flap was the commonest flap performed (38.46%). The overall complication rate was 58.33%. Orocutaneous fistula was the commonest (22.22%). The partial flap loss occurred in 8.33% (15.1%) and the total flap loss occurred in three free flaps. Conclusion: The difficulties experienced in OC reconstruction were high complication rates, multiple redo surgeries, and extended hospital stays. Despite these challenges, all of our patients were released from the hospital with stable wound coverage. Furthermore, the study will provide a platform for a better understanding of the oral cancer reconstruction scenario in the context of Nepal.

Patient-specific Prosthetic Appliance for Interim Management of Chronic Orocutaneous Fistula in the Irradiated and Vessel-depleted Head and Neck Patient – A Case Report and Technical Note

The formation and persistence of an orocutaneous fistula as a sequela of major head and neck surgery followed by microvascular reconstructive surgery and adjuvant radiation therapy is a common and frustrating challenge to address. When reconstructive surgical options are exhausted, limited, or with high risk for failure, the fabrication of an oral appliance can provide a temporary to long-term treatment option for the patient. In this case report, an oral appliance was fabricated to decrease salivary incontinence, improve intelligibility, and deglutition in a 60-year-old patient who underwent a subtotal glossectomy with radical mandibulectomy followed by reconstruction with an osteocutaneous radial forearm free flap who developed a chronic orocutaneous fistula following completion of radiation therapy.

Bipaddled Pectoralis Major Myocutaneous Flap in Complex Oral Cancer Defects- A Single Center Experience with Quality of Life Assessment.

Advanced stage malignancies of oral cavity commonly result in complex full thickness defects with subsequent functional and aesthetic loss. Through this article we describe our center's experience in reconstruction of such defects with bipaddled pectoralis myocutaneous (PMMC) flap through an immediate, single-staged procedure. The study included a total of 54 patients who underwent composite resection and neck dissection followed by reconstruction of the defect with bipaddled PMMC flap. All patients were followed up post-operatively for 1 year and were monitored for flap and donor site related complications. Using University of Washington Quality of life v4 questionnaire (UW-QOL4), we assessed the QOL of 54 patients. The mean scores were compared to other similar studies. Results: The overall complication rate was 66.6%, whereas, 33.3% patients had no complications. The most common complication was wound dehiscence seen in 31.5% of cases in the recipient site and 12.9% in the donor site. Other complications were seroma, hematoma, plate exposure, orocutaneous fistula etc. Around 73.7% patients reported a good, very good or outstanding overall quality of life in the post-operative period. The mean composite QOL score was 65.84. Our study showed comparable domains of pain, appearance, activity, recreation, swallowing, chewing, speech, shoulder function and taste with other similar studies. Conclusion: Bipaddled PMMC flap proves to be a considerable alternative for microvascular free flaps in reconstruction of full-thickness defects of oral cavity owing to its reliable blood supply, accessibility, easier harvesting technique, cost effectiveness, high success rate and acceptable quality of life. The online version contains supplementary material available at 10.1007/s12070-022-03324-6.