Outcome of indian oral cancer surgical ablation defects reconstruction by various flaps

Introduction: Lower Gingivo Buccal Sulcus (GBS) is a major sub site for oral squamous cell carcinoma (SCC) in the Indian subcontinent. The gold standard management of Lower GBS cancer is surgical ablation which creates sometimes large defects. Currently, micro vascular free tissue transfer is considered as ideal choice for oral cavity reconstruction. This prospective study describes the outcome of Indian oral cancer surgical ablation defects reconstruction by various flaps.
Materials and Methods: The current prospective study was conducted in the Department of Surgical Oncology at tertiary health care centre. Staging work up done with CECT Scan, X ray chest. Procedures performed are wide local excision of Primary with Manibulectomy (Marginal, Segmental or Hemi) with neck dissection as per standard protocol. Reconstruction was made with PMMC flap, Naso labial flap, free radial forearm flap, antero lateral thigh flap and free fibula flap based on defects.
Results: Total number of Lower GBS cancer included in our study is 130 and all patients underwent reconstruction by various flaps. 78 patients (60%) belong to 40 -50years and male predominance. In our study, Majority (56.9%) underwent PMMC flap reconstruction followed by radial free forearm flap (21.5%). Cosmetic outcome and Functional outcome are better with Micro vascular flap than PMMC flap .Among the recurrences, Local recurrences are common (8.5%).
Conclusion: Reconstruction of Lower Gingivo Buccal cancer post surgical ablation defects are challenging due to their complex three dimensional natures. For large complex defects, Micro vascular free flap provides better Cosmetic and Functional outcome compare to PMMC flap.