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<p>Reconstructive choice in oral squamous cell carcinoma (OSCC) significantly influences postoperative function, aesthetics, and quality of life. Although free flaps are the gold standard in high-resource settings, their broader applicability in low- and middle-income countries (LMICs) warrants evaluation. This study compared outcomes of local, regional, and free flap reconstructions in OSCC patients treated at a tertiary Indian center. This retrospective cohort included 30 consecutive patients who underwent tumour resection and flap reconstruction between January 2020 and December 2022. Reconstruction types comprised local (<i>n</i> = 6), regional PMMC (<i>n</i> = 12), and free flaps (radial forearm = 5, fibula = 4, anterolateral thigh = 3). Functional outcomes were evaluated using the Functional Oral Intake Scale (FOIS) and a standardized speech intelligibility score at 3&#xa0;months. Aesthetic results were graded at 6&#xa0;months by two independent blinded surgeons. Complications within 3&#xa0;months were classified as major or minor. Multivariate logistic regression identified predictors of postoperative complications. Median follow-up was 9&#xa0;months (IQR 6–14). Free flaps achieved the highest median FOIS score (7; 95% CI 6.5–7.0) and the best aesthetic outcomes (Excellent/Good = 83%). Regional PMMC flaps had the highest complication rate (50%), including the only total flap loss, while free flaps had the lowest (8%). Significant predictors of complications included diabetes mellitus (OR 4.2; <i>p</i> = 0.01), Stage IV disease (OR 3.7; <i>p</i> = 0.03), and postoperative radiotherapy (OR 3.1; <i>p</i> = 0.04). Free flap reconstruction showed a protective trend (OR 0.4; <i>p</i> = 0.08). Free flap reconstruction demonstrated superior functional and aesthetic outcomes with lower complication rates, even in a resource-constrained setting. However, these findings should be interpreted with caution due to the small sample size, retrospective design, and limited follow-up. The study emphasizes incorporating objective functional metrics into reconstructive planning and supports further prospective, multicentric research in LMIC environments.</p>

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Functional and Aesthetic Outcomes of Flap Reconstruction in Oral Cancer: a Tertiary Indian Cohort Study

  • 期刊论文

  • 发表日期：

    2025年12月8日

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  • Surjeet Dwivedi,
  • Sanjay Kumar,
  • Chandan Sinha,
  • Pranay Pratap,
  • Munish Malhotra,
  • A. Dutta,
  • Manoj Kumar,
  • Varun Kumar Agrawal,
  • Sabita Dwivedi

摘要

Reconstructive choice in oral squamous cell carcinoma (OSCC) significantly influences postoperative function, aesthetics, and quality of life. Although free flaps are the gold standard in high-resource settings, their broader applicability in low- and middle-income countries (LMICs) warrants evaluation. This study compared outcomes of local, regional, and free flap reconstructions in OSCC patients treated at a tertiary Indian center. This retrospective cohort included 30 consecutive patients who underwent tumour resection and flap reconstruction between January 2020 and December 2022. Reconstruction types comprised local (n = 6), regional PMMC (n = 12), and free flaps (radial forearm = 5, fibula = 4, anterolateral thigh = 3). Functional outcomes were evaluated using the Functional Oral Intake Scale (FOIS) and a standardized speech intelligibility score at 3 months. Aesthetic results were graded at 6 months by two independent blinded surgeons. Complications within 3 months were classified as major or minor. Multivariate logistic regression identified predictors of postoperative complications. Median follow-up was 9 months (IQR 6–14). Free flaps achieved the highest median FOIS score (7; 95% CI 6.5–7.0) and the best aesthetic outcomes (Excellent/Good = 83%). Regional PMMC flaps had the highest complication rate (50%), including the only total flap loss, while free flaps had the lowest (8%). Significant predictors of complications included diabetes mellitus (OR 4.2; p = 0.01), Stage IV disease (OR 3.7; p = 0.03), and postoperative radiotherapy (OR 3.1; p = 0.04). Free flap reconstruction showed a protective trend (OR 0.4; p = 0.08). Free flap reconstruction demonstrated superior functional and aesthetic outcomes with lower complication rates, even in a resource-constrained setting. However, these findings should be interpreted with caution due to the small sample size, retrospective design, and limited follow-up. The study emphasizes incorporating objective functional metrics into reconstructive planning and supports further prospective, multicentric research in LMIC environments.