Functional Outcomes of Free Flap Reconstruction after Head and Neck Cancer Resection: A Prospective Study

Abstract

Background: Head and neck cancer resection frequently results in complex composite defects affecting speech, swallowing, and facial aesthetics. Free tissue transfer has become the gold standard for reconstruction, yet outcome data from Indian centres with high oral cancer burden remain limited. This study evaluated flap survival and functional outcomes after free flap reconstruction following head and neck cancer ablation. Methods: A prospective observational study was conducted among 65 consecutive patients undergoing free flap reconstruction after head and neck cancer resection at a regional cancer centre in India from January to December 2023. Flap type was selected based on defect characteristics. Outcomes assessed included flap survival, intraoperative and postoperative complications, and functional outcomes at 3 and 6 months including speech intelligibility, swallowing function (Functional Oral Intake Scale), facial contour, and donor site morbidity. Multivariate logistic regression identified predictors of complications. Results: The mean age was 54.2 ± 11.6 years with 72.3% males. The anterolateral thigh flap was the most commonly used (43.1%), followed by radial forearm (27.7%) and fibula (20.0%). Overall flap survival was 93.8%. Major complications occurred in 15.4%, including total flap loss in 6.2% and partial loss in 4.6%. At 6 months, acceptable speech intelligibility (above 75%) was achieved in 72.3%, adequate oral diet (FOIS 5 or above) in 78.5%, and tracheostomy decannulation in 89.2%. Independent predictors of complications were operative time exceeding 8 hours (adjusted OR 3.82, p = 0.006), prior radiation therapy (aOR 3.14, p = 0.012), and diabetes mellitus (aOR 2.46, p = 0.034). Conclusion: Free flap reconstruction achieved 93.8% survival with acceptable functional rehabilitation in the majority of patients. Prior radiation and prolonged operative time were the principal risk factors for complications. Dedicated microsurgical teams and standardised postoperative flap monitoring protocols are essential for optimising outcomes