Early Feeding After Free Flap Reconstruction for Oral Cavity Cancer: A Single Institution Retrospective Review

Patients undergoing free flap reconstruction of the oral cavity have traditionally received nothing by mouth for 6-14 days postoperatively to limit the risk of wound complications. Growing evidence suggests that initiation of oral intake may not increase the morbidity. This study further investigates the utility of "early feeding."

This was a retrospective cohort study conducted at a large, urban tertiary healthcare system. Patients who underwent free flap reconstruction for oral cavity cancer between June 1, 2020, and October 31, 2022, were grouped as early feeding (oral intake on or before Postoperative Day 5) or late feeding (LF) (oral intake after Postoperative Day 5). Outcomes included rate of orocutaneous fistula, development of other local or systemic complications, and hospital length of stay (LOS).

Sixty six patients were studied, with 26 belonging to the LF group and 40 to the early feeding (EF) group. The LF group was significantly older (median age 64.5 vs. 80 years, p = 0.027) and more likely to have a defect extending beyond the oral cavity (25.0% vs. 50.0%, p = 0.037). No significant differences were found in orocutaneous fistula formation between the LF and EF groups (7.7% vs. 0%, p = 0.152), but the rate of total complications was significantly higher in the LF group (38.5% vs. 12.5%, p = 0.014). LOS was significantly longer in the LF group (12.5 vs. 6 days, p < 0.001).

These findings suggest that in the correctly suggested patient population, early postoperative oral intake may facilitate earlier hospital discharge without increasing the risk of postoperative complications.