Evaluacija uspješnosti rekonstrukcije usne šupljine podlaktičnim i perforatorskim režnjem [The effectivness of oral cavity reconstruction using forarm and perforator flaps]

The study included the patients treated at the Clinic for Maxillofacial Surgery at „Dubrava“ Clinic Hospital in Zagreb who were planned for microvascular reconstruction using forearm or thigh perforator flaps. Patients with oral cavity cancer were evaluated and placed in two groups (20 in each group), based on the type of perforator flap used for defect reconstruction. Postoperative functional results were evaluated during regular follow up visits through a specifically designed clinical questionnaire. Moreover, an objective voice analysis was done using the acoustic voice analysis Multi-Dimensional Voice program (MDVP). Oral cavity is a specific region, mostly due to the fact that most structures and functions are closely interrelated. Tumor resection defects are commonly reconstructed with the most adequate free flap which enables the patients to have reasonably normal functions of chewing, swallowing, voice articulation and speech. Postoperative prosthetic rehabilitation, duration of hospitalization, local complications with reconstruction and postoperative activity do not depend on the flap type. Length of hospitalization depended primarily on the general condition of the patient and comorbidity and then on the stage of the ailment. The results of this study show that postoperative decannulation and the duration of feeding through the nasogastric tube depends on the stage of the ailment, regardless of the flap choice for reconstruction. Decannulation was the fastest in stage 1, and statistically significantly faster in women. The fastest postoperative mouth eating was in the patients who had stage 1 disease and postoperative speech ability. Speech ability after surgery is not significantly dependent on the extent of resection and the type of dissection. Postoperative speech in patients in both groups, according to the patients and their physicians, was significantly better in the first months after surgery than a year later. The deterioration of the speech ability can be explained by the scar tissue and flap atrophy itself. The majority of patients were not concerned about the aesthetic appearance of the flap (hair coverage), however, they were mostly concerned about the layout and functionality of the donor region and the overall aesthetic impression. The data showed that the success of oral cavity reconstruction and a better quality of life of patients with tumor of head and neck do not directly depend on the reconstruction method.