RECONSTRUCTION OF TWO DISCRETE SURGICAL DEFECTS IN HEAD AND NECK IN THE ABSENCE OF FREE FLAPAVAILABILITY-AN INSTITUTIONAL EXPERIENCE

Abstract

Introduction: Operable oral and oropharyngeal tumors with extra nodal extension inltrating the skin at level II to V require resection of primary and extended radical neck dissection can result in a defect at both primary and neck with intervening normal tissue. Ideally they need to be reconstructed with a chimeric free ap but in cases where it was not possible, locoregional aps were utilized. Aim-To discuss and compare our experience with various methods to reconstruct two discrete defects. Materials And Methods: This is a retrospective study from the Head Neck Oncology Dept of a Kidwai Memorial Institute Of Oncology, Bangalore, India between March 2016 – August 2021. A total of 14 were included in this study and divided into 3 groups. Group-1 included Pectoralis Major Myocutaneous Flap (PMMC) in a dual island technique, group-2 included reconstruction with combination of two locoregional aps. Group-3 included reconstruction with PMMC with split skin graft(SSG) covering for external defect. Results: The time taken to raise a dual-islanded PMMC and for PMMC with split thickness skin grafting an average is 50minutes compared to group-2- 90minutes. The time for insertion into the defects were one-and-a -half times more in the group-2 than other groups. No patients in group 1 and group 2 had a delay in receiving adjuvant treatment, whereas 50% of patient in group-3 could not receive adjuvant radiotherapy on time due to delayed wound healing. Conclusion- any of the three options can be considered for reconstruction of two discrete defects. PMMC with dual island technique found to be the most effective one with shorter operating time and with the least complication rate.