Microvascular free flap reconstruction for head and neck cancer in a resource-constrained environment in rural India

ABSTRACT

Introduction: Reconstruction with free flaps has significantly changed the outcome of patients with head and neck cancer. Microsurgery is still considered a specialised procedure and is not routinely performed in the resource-constrained environment of certain developing parts of India. Materials and Methods: This article focuses on the practice environment in a cancer clinic in rural India. Availability of infrastructure, selection of the case, choice of flap, estimation of cost and complications associated with treatment are evaluated and the merits and demerits of such an approach are discussed. Results: We performed 22 cases of free flaps in a six-month period (2008-2009). Majority (17) of the patients had oral cancer. Seven were related to the tongue and eight to the buccal mucosa. Radial forearm free flap (RFF: 9) and anterolateral thigh flap (ALT: 9) were the most commonly used flaps. A fibula flap (1) was done for an anterior mandible defect, whereas a jejunum free flap (1) was done for a laryngopharyngectomy defect. There were six complications with two re-explorations but no loss of flaps. Conclusion: Reconstruction with microvascular free flaps is feasible in a resource-constrained setup with motivation and careful planning.

KEY WORDS

Free flap - head and neck cancer - microvascular surgery - reconstruction - resource constrained - reconstruction of head and neck

• 1 Sanabria A, Domenge C, D′cruz A, Kowalski LP. Organ preservation protocols in developing countries. Curr Opin Otolaryngol Head Neck Surg 2010;18:83-8.
• 2 Rothwell PM. Factors that can affect the external validity of randomized controlled trials. PLoS Clin Trials 2006;1:e9.
• 3 Rothwell PM. External validity of randomised controlled trials: ′To whom do the results of this trial apply?′. Lancet 2005;365:82-93.
• 4 Sankaranarayanan R, Masuyer E, Swaminathan R, Ferlay J, Whelan S. Head and neck cancer: A global perspective on epidemiology and prognosis. Anticancer Res 1998;18:4779-86.
• 5 Sanghvi LD, Rao DN, Joshi S. Epidemiology of head and neck cancer. Semin Surg Oncol 1989;5:305-9.
• 6 Jayalekshmi PA, Gangadharan P, Akiba S, Nair RR, Tsuji M, Rajan B. Tobacco chewing and female oral cavity cancer risk in Karunagappally cohort, India. Br J Cancer 2009;100:848-52.
• 7 Hashibe M, Jacob BJ, Thomas G, Ramadas K, Mathew B, Sankaranarayanan R, et al. Socioeconomic status, lifestyle factors and oral premalignant lesions. Oral Oncol 2003;39:664-71.
• 8 Reddy SK, Gupta PC. Report on tobacco Control in India. Ministry of Health and Family Welfare, Government of India: New Delhi; 2004.
• 9 Chen WQ. Estimation of cancer incidence and mortality in China in 2004-2005. Zhonghua Zhong Liu Za Zhi 2009;31:664-8.
• 10 Arsenijevic S, Pantovic V, Gledovic Z, Stojanovic J, Belic B. Demographic characteristics of patients with laryngeal cancer and their socioeconomic status. J BUON 2010;15:131-5.
• 11 Elango JK, Gangadharan P, Sumithra S, Kuriakose MA. Trends of head and neck cancers in urban and rural India. Asian Pac J Cancer Prev 2006;7:108-12.
• 12 Allareddy V, Konety BR. Characteristics of patients and predictors of in-hospital mortality after hospitalization for head and neck cancers. Cancer 2006;106:2382-8.
• 13 Hillner BE, Smith TJ, Desch CE. Hospital and physician volume or specialization and outcomes in cancer treatment: Importance in quality of cancer care. J Clin Oncol 2000;18:2327-40.