Comparison of reconstructive methods used following ablative head and neck operations

To overcome the sometimes crippling effect of extensive ablative surgery for oral cancer, two reconstructive techniques, the forehead flap of McGregor and the deltopectoral flap described by Bakamjian, have been incorporated into the operative procedure making it nearly routine. The records of 77 patients in whom 55 deltopectoral flaps and 30 forehead flaps were used were reviewed retrospectively. The failure rate of deltopectoral flaps was 16.4% and for forehead flaps was 7%. Causes of failure included infection, pressure by bone, prosthesis or teeth, residual cancer, previous irradiation and flap crowding. Functional results were similar with both flaps. The forehead flap is preferred although it has cosmetic disadvantages. Both these flap procedures, which are staged and result in prolonged hospitalization for the patient, may in the future be replaced by myocutaneous and free-flap reconstructions.