Perioperative Outcomes in Locally Advanced Head and Neck Cancers Reconstructed using Free Flap : Early Experience at...

Head and neck squamous cell cancers (HNSCC) are one of the most common cancers in India. According to GLOBOCAN 2020, there will be 2.1 million new cancer cases in India by 2040, Head and neck cancer (HNC), in particular, accounts for 30% of the all-cancer cases. Treating HNSCC is a difficult task for surgeons since most of the cases in our country present at advanced stages. One of the biggest hurdles in reconstruction of the defects of these complex cases is the ability to perform microvascular flaps. Many advanced HNSCC which were previously considered inoperable, are now operable with the use of microvascular surgery reconstruction. All patients of HNSCC who underwent resection and free flap reconstruction in the Department of Surgical Oncology at a tertiary health care centre from February 2023 to October 2024 were included in the study. It is a retrospective analysis of the data collected from the treated patients. A total of 60 patients were included, comprising 48 males and 12 females, with the majority presenting in Stage III or IV disease. Three types of free flaps were used: anterolateral thigh (ALT) (n = 38), radial artery forearm (RAFF) (n = 18), and free fibula (n = 4). The facial artery was the most common recipient vessel (44 cases), followed by the superior thyroid artery (16 cases). Fourteen patients (23.3%) required early re-exploration for flap perfusion issues (n = 12) or bleeding (n = 4). The overall flap success rate was 83.3%, with a salvage rate of 16.7% (2/12). The mean operative duration was 4.2 h for ALT, 4.0 h for RAFF, and 6.0 h for fibula flaps, showing progressive reduction with experience. Postoperative oral competence and swallowing outcomes were satisfactory, with 70% achieving intelligible speech and 75% reporting good aesthetic and social acceptance at 6 months. Microvascular surgical reconstruction has changed the landscape of management of locally advanced head and neck squamous cell cancers (LAHNSCC). Because the donor site is morbidity is less free flap reconstruction offers surgeons the opportunity to improve the healing process and leads to better functional and aesthetic outcomes.