Management of Through-and-Through Oromandibular Defects after Segmental Mandibulectomy with Fibula Osteocutaneous Flap.

BACKGROUND: Oromandibular defects involving the external skin are a reconstructive challenge. This study aimed to evaluate the use of the fibula osteocutaneous free flap (FOCFF) for through-and-through oromandibular defects by comparing the surgical outcomes and complications of different techniques to close the external skin defect. METHODS: A retrospective analysis was conducted of patients who underwent reconstruction of through-and-through oromandibular defects after oncologic segmental mandibulectomy between January 2011 and December 2014. Five groups were analyzed according to the method of external skin coverage: primary closure, locoregional flaps, deepithelialized double-skin paddle FOCFF (deEpi-FOCFF), division of the skin paddle for double-skin paddle FOCFF (div-FOCFF), and a simultaneous second free flap. Intraoperative and postoperative outcomes along with complications were analyzed between groups. RESULTS: A total of 323 patients were included. The mean total defect area requiring a simultaneous second free flap was larger in comparison to other groups (p < 0.001). Reconstructions performed with div-FOCFF had a higher number of perforators per flap when compared with deEpi-FOCFF (p < 0.001). External defects closed with another free flap exhibited higher intraoperative time for the reconstructive segment in comparison to other groups (p < 0.05). The overall rate of complications was comparable between groups (24%, p = 0.129). CONCLUSION: The FFOCF is a reliable alternative to harvesting multiple simultaneous free flaps for through-and-through oromandibular defects. The authors recommend appropriate curation of the surgical plan based on individual patient characteristics and reconstructive requirements.

Outcome Analysis of Advanced Oral Cancers Requiring Large Composite Fibular Osteocutaneous Flap Reconstruction: Experience From a Tertiary Care Cancer Hospital.

BACKGROUND: Advanced oral cancer entailing extensive resection of large parts of the mucosa, bone, and skin require reconstructions with composite free flaps. Our aim was to analyze the outcomes of those oral squamous cell carcinomas requiring fibular osteocutaneous free flaps with large skin defects. METHODS: Perioperative course and histopathological and survival outcomes of 246 consecutive patients warranting composite fibular flaps from January 2010 to June 2015 at Tata Memorial Hospital, Mumbai, India, were retrospectively analyzed. RESULTS: Despite majority of T4 disease (88.2%) and stage IV disease (92%) patients, the 5-year overall survival was 52.1% and the 5-year recurrence-free survival was 48.6% with a median follow-up of 42 months with minimal complications. CONCLUSIONS: Reconstruction with composite fibular osteocutaneous flaps has comparable outcomes of survival with acceptable complications in mega oral squamous cell carcinomas requiring extensive resection.

Carcinoma stomach: unwanted chemotherapeutic success: a case vignette.

A 45-years-old male, chronic smoker and occasional alcoholic, from Tamenlong district of Manipur was admitted to the department of Surgery, RIMS, Imphal on 19(th) August, 2011. He was diagnosed as a case of poorly differentiated adenocarcinoma of the stomach located at incissura along the lesser curvature. CT scan of abdomen had revealed para-aortic, aorto-caval and celiac lymphadenopathy. Patient had undergone 5 cycles of neo-adjuvant chemotherapy consisting of 3 weekly course of Oxaloplatin 80mg(D1) + epirubicin 200mg (D1) + Capicitabine 2000mg(D1-D14). After 1 month of chemotherapy, patient then underwent subtotal gastrectomy (modified D2 resection) without any significant peri-operative complication. Surprisingly, the final histopathological report of the resected specimen didnx't reveal any evidence of malignancy in any sections. Role of chemotherapy in gastric cancers has been an adjunct to surgery and the optimal drugs regimen has not been elucidated so far. Till now, very few cases of carcinoma stomach which show pathological complete response have been reported. Our case is such a rare case of pathological complete response following neoadjuvant chemotherapy.