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National Journal of Maxillofacial Surgery
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Year : 2018  |  Volume : 9  |  Issue : 2  |  Page : 191-195

Reconstruction in head-and-neck cancers – analysis of the learning curve

1 Department of Surgical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
2 Department of Plastic and Reconstructive Surgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India

Correspondence Address:
Dr. Ranganath Ratnagiri
Department of Surgical Oncology, Room No. 404, Fourth Floor, Speciality Block, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad - 500 082, Telangana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/njms.NJMS_66_17

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Background: Oral cancers are some of the most common cancers in India. Most patients present with locally advanced disease requiring extensive resection resulting in large defects. Reconstruction of these defects plays a major role in restoring form and function to these patients, as well as enabling the delivery of adjuvant therapy on time. Aim of the Study: The aim of this study was to analyze the learning curve involved in microvascular surgery. Materials and Methods: A retrospective analysis of the case records of all patients of oral cancers, who underwent resection and reconstruction between January 2008 and December 2012 at our institute, was done. Demographic, clinical, and pathological data were collected and analyzed. Statistical analysis was done using the SPSS software. Results: The operative time and the postoperative ventilation (7.8 h and 3.7 days, respectively) were significantly higher than those for pedicled flaps (3.6 h and 1.4 days, respectively). Both these variables reached statistical significance with P < 0.05 and < 0.04. The hospital stay was also statistically significantly longer for patients who underwent free-flap reconstruction (17.9 days vs. 7.9 days; P < 0.05). The number of reexplorations were higher in the free-flap group (31), when compared to the pedicled flap group (9). However, partial flap loss was higher in the pedicled flap subset when compared to the free-flap group. The complications significantly dropped after the performance of 30–40 free flaps. Conclusion: There is a steep learning curve in microvascular surgery, but the cosmetic and functional outcomes outweigh the complications.

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