ABSTRACT
Background: Extensive composite defects of the oromandibular site involve skin, mandible, soft tissue and oral mucosa. Though many opine that with the coming on of free flap surgery, the pedicled flap is an outdated surgical option, the latter still has its uses. Free flaps are criticized as being medically risky, expensive, and time-consuming. Combining both these flaps in a single surgery would bring in the baggage of all negatives along with the benefits of these flaps.Methods: Over a period of 3 years, 13 patients with expected large composite oral defects after ablative surgery for malignancy were included in the study requiring both skin cover and mucosal lining. A one-stage reconstructive procedure employing combination of free and pedicled flaps was used. Data was abstracted pertaining to cancer demography and surgical outcome.Results: The free fibula osteocutaneous flap (FFOCF)- deltopectoral fasciocutaneous flap (DPF) combination was most commonly used (n=5), secondly by free radial forearm flap (FRAFF)-DPF combination (n=4), FRAFF- pectoralis major myocutaneous flap (PMMF) amalgamation and FFOCF-PMMF (n=2). The complete flap survival rate was 88.5 percent with 3.8% percent total (1 of 26 flaps) and 7.7% partial (2 of 26 flaps) flap failures. Minimum follow-up period was 6 months with 2 (7.7%) recurrences and 2 (7.7%) mortalities.Conclusions: We believe that in combined use of free-flap and pedicled flap procedure for one-stage reconstruction of massive mandibular defects with through-and-through cheek defects is justified because it is safe and effective and improves the quality of life for these patients albeit a bit prolonged surgery which can effectively be shortened with 2 reconstructive team approach as in our study.
ABSTRACT
Background: Open fractures of leg classified under type IIIB, those requiring free flap cover could be done as emergency procedure. The ideal timing has still remained controversial. Although it appears imperative to operate early and reduce length of hospital stay, costs, disability adjusted life years and put the patient back on his feet, our study was necessitated in the context of differing views regarding ideal timing of free flap.Methods: The prospective observational study was conducted for duration of 4 years between October 2015 to September 2019. Patients were taken up for free flap cover after optimization for the major surgery. Details of flap complications and the procedures for salvage were noted. At the end of one year following the injury, patient quality of life (PQOL) was tabulated for all patients.Results: Most common mode of injury was road traffic accidents. Early flaps were done in 28 and primary flaps in 22 patients. One patient had partial flap necrosis while 7 others had sub flap collections and partial flap necrosis. Duration of hospitalization was significantly lower in early flap cover group. PQOL measured with EQ-5D (EuroQol 5D) was significantly higher in the early flap covers.Conclusions: From our study we concluded that timing of free flap cover positively influenced clinical outcome of reduced hospitalization, although there was no relation of timing of free flap to flap or bone complications. The functional outcome measured by PQOL was significantly higher in patients who had microvascular reconstruction early.