Microsurgical reconstruction of the through-and-through defect in head andneck cancer: Is it worth it?

As health resources diminish, there are compelling reasons to utilize healt h dollars in a fiscally responsible manner. The reconstruction of complex o romandibular defects involving mucosa, bone, and skin coverage poses one of the greatest challenges in microsurgery of the head and neck. The cancer p atient who requires a through-and-through resection and microsurgical recon struction usually has a poor prognosis. In this study, the authors examine whether this type of surgery is worthwhile in terms of cost, functional out come, and patient satisfaction. Of 16 cases of through-and-through oromandibular reconstruction performed, the survival outcome of ten (n = 10) advanced cases requiring immediate oro mandibular reconstruction (7 radial forearm flaps; 3 scapular flaps) is pre sented. Six cases were considered cured and required delayed reconstruction . Seven of the 10 patients died within 39 months postoperatively, while thr ee survived up to 68 months postoperatively. The combined experience of these ten patients was examined using the Kaplan -Meier (product-limit) estimator of the survival curve. Results show that o f the seven patients who died of disease, five did so within the first post operative year. More important, among those Five patients who survived for more than one postoperative year, three were still alive up to 68 months, r epresenting a combined total of over 15 postoperative years. The probability of long-term survival is good in through-and-through oroman dibular cancer patients who can survive to 1 year postoperatively, and it i s proposed that microsurgical reconstruction,albeit costly, remains a worth while procedure.