FUNCTIONAL RESULTS AND SURVIVAL RATES OF PATIENTS WITH CANCER OF THE ORAL CAVITY AND OROPHARYNX AFTER RECONSTRUCTION WITH RADIAL FOREARM FLAP

In tumor surgery of the oral cavity and oropharynx function and qualit y of life should be maintained and large resection margins to avoid re currences. For these purposes the radial forearm flap has proved to be a versatile tissue transfer since it is thin and pliable and has a lo ng vascular pedicle. From 1987 to 1991 we used the radial forearm flap in performing 70 reconstructions of the oral cavity and oropharynx af ter resection of squamous cell carcinomas. Forty-six patients had carc inomas of the oropharynx, while 24 patients had carcinomas of the oral cavity. The indications for these reconstructions were tumors of the oral cavity and oropharynx greater than T2 which after resection were not suitable for primary closure of the defect. Thirty-seven patients died during the follow-up period, with 36% dying within the first 2 ye ars after operation. Fifty-five percent of these patients died of recu rrences, 17% of metastases and 11% of intercurrent diseases. In 17% of cases the cause of death was unknown. The 2-year survival probability was 52% (Kaplan Meier). Our results show that reconstructions with th e radial forearm flap do not improve survival rates when compared to t he general survival rate in these cases despite a possibly larger rese ction margin allowing a more radical tumor resection. Thirty-one of th e 33 patients still alive underwent following examinations. Forty-six percent of the patients with tumors of the oropharynx and 57% of the p atients with tumors of the oral cavity had severe difficulties in swal lowing. Speech function was reduced in 46% of the patients with oropha ryngeal tumors and in all patients with tumors of the oral cavity. Res piration was slightly altered in 29% of patients with tumors of the or opharynx and in 14% of patients with tumors of the oral cavity. These problems in many cases were also due to some extent to postoperative r adiotherapy. Despite the unchanged survival rates compared to patients without reconstructions and limited functional results, we still reco mmend the radial forearm flap as an adequate reconstructive method wit h low donor morbidity. The best indication in our opinion is reconstru ction of the soft palate and lateral wall of the oropharynx whereas pr oblems may occur in reconstruction of the anterior part of the tongue and floor of mouth. In these cases very often significantly reduced mo bility of the tongue results.