Treatment result of immediate reconstructive surgery by major cutaneous and myocutaneous flaps on oral cancer therapy

One hundred and four immediate reconstructions for major orofacial defects following oral cancer surgery were performed in 103 patients using 115 various cutaneous and myocutaneous flaps during the 10-year period from 1979 to 1989. A retrospective analysis of the cases was carried out and the treatment result was presented.Reconstructive cutaneous or myocutaneous flaps were composed of pectorals major myocutaneous flap (PMMC) in 68 cases, latissimus dorsi myocutaneous flap (LDMC) in 19 cases, free radial forearm flap (FA) in 10 cases, deltopectoral flap (DP) in 10 cases, and other miscellaneous flaps in 8 cases. Near the half of the cases had a tongue cancer followed by cancers of the lower alveolus and gingiva, floor of the mouth, buccal mucosa and so on. Ninety-nine cases had squamous cell carcinomas. Seventy-seven cases were treated as primary treatment, whereas 27 cases were secondarily treated against recurrence after previous treatmentsincluding radiotherapy and/or surgery. TNM classification was also applied to recurrent cases at the time of reconstructive surgery, and 49 cases were classified into T4, 55 cases were N1 to N3, then 58.6% of the cases were Stage IV. The mean operation time of 104 cases was 10 hours and 16 minutes, and the average total blood loss was 3, 562 grams. Complete survival of the reconstructed flaps was obtained in about 60%, and 29% of the cases showed a minor loss, however, a major loss and total necrosis of the flap were observed in 10.4% and 1.7% respectively.Recurrence of tumor at any sites of the body was observed in 48%. The recurrence rate was 43% in Stage II, 27% in Stage III and 57% in Stage IV. Recurrence after reconstructive surgery was observed in 29% in the primary sites, 34% in the regional cervical lymph nodal areas, and 17% as distant metastases. Ten years cummulative survival rate was 42.8% in total cases, 67.2% in Stage II, 61.9% in Stage III, and 27.6% in Stage IV by Kaplan-Meier's method. The cummulative survival rates in the primary treatment group for each stage were compared with those of control groups treated without immediate reconstructive sur-gery, disclosing no difference in Stage II, slightly higher in the reconstructive group for Stage III, and 12% higher in the same group for Stage IV. However, the difference was not statistically significant.