A Proposal for Orocutaneous Fistula Grading Following Oral Cancer Surgery

Orocutaneous fistula (OCF) is a common postoperative complication encountered following surgery for oral cancers with multiple implications. There is no grading system available for this complication which has so many implications that would help in its uniform reporting and management. In this study, we have included patients with oral squamous cell carcinoma operated on between January 2021 and December 2021 and tested a proposed three-tier grading system (grades 1-3) for OCF. Out of the 284 patients at risk of OCF, 37 (13%) patients developed OCF in this cohort. Six patients had grade 1 OCF, 20 patients had grade 2 OCF, and 11 patients had grade 3 OCF. Patients with a higher grade of OCF had prolonged hospital stays and required multiple surgical debridements and/or resuturings, and a few needed another flap, which was statistically significant. The proposed grading system for OCF appears to be useful in grading this complication. However, this needs to be validated in a prospective study across multiple centres.