Head and Neck Cancer Reconstruction with or without Internal Lining Using Various Flaps in a Tertiary Care Hospital
Head and Neck Cancer Reconstruction: Internal Lining Using Various Flaps
DOI:
https://doi.org/10.54393/pjhs.v6i7.3380Keywords:
Surgical Reconstruction, Surgical Flaps, Cosmetic Surgery, Internal LiningAbstract
Reconstructive surgeries of the head and neck with or without the use of internal lining must be thoroughly evaluated for post-operative complications and functional outcomes unclear phrasing. Objectives: To compare the surgical outcomes, complication rates, and functional outcomes of head and neck cancer reconstruction surgeries performed with or without internal lining using various flap techniques in a Tertiary Care Hospital setting. Methods: This one-year prospective comparative study at Al-Tibri Medical College included 139 head and neck cancer patients undergoing resection and reconstructive surgery with or without internal lining. Data on demographics, tumor, surgical, and postoperative outcomes were analyzed using SPSS version 23.0, applying appropriate statistical tests with significance set at p<0.05. Results: From 139 patients, operative time was significantly longer in Group A (with flap and internal lining) than in Group B (p<0.001). Postoperative complications were more common in Group A, with higher rates of wound infection (15.7% vs. 5.8%, p=0.04) and overall complications (28.6% vs. 11.6%, p=0.01). Functional outcomes favored Group B, with significantly better swallowing (82.6% vs. 55.7%, p=0.007) and speech intelligibility (79.7% vs. 60%, p=0.04). Hospital stays over 7 days were more common in Group A (35.7% vs. 14.5%, p=0.009). The need for secondary intervention was higher in Group A, but not statistically significant. Overall, Group B demonstrated fewer complications and better postoperative functional recovery. Conclusions: Head and neck reconstruction without internal lining resulted in fewer complications, shorter hospital stay, and better functional recovery than reconstruction with internal lining. Careful patient selection can optimize outcomes and surgical efficiency.
References
Chow LQ. Head and Neck Cancer. New England Journal of Medicine. 2020 Jan; 382(1): 60-72. doi: 10.1056/NEJMra1715715.
Gupta B, Johnson NW, Kumar N. Global Epidemiology of Head and Neck Cancers: A Continuing Challenge. Oncology. 2016 Jun; 91(1): 13-23. doi: 10.1159/000446117.
Chim H, Salgado CJ, Seselgyte R, Wei FC, Mardini S. Principles of Head and Neck Reconstruction: An Algorithm to Guide Flap Selection. In Seminars in Plastic Surgery. 2010 May; 24(02): 148-154. doi: 10.1055/s-0030-1255332.
Spoerl S, Schoedel S, Spanier G, Mueller K, Meier JK, Reichert TE et al. A Decade of Reconstructive Surgery: Outcome and Perspectives of Free Tissue Transfer in the Head and Neck. Experience of A Single Center Institution. Oral and Maxillofacial Surgery. 2020 Jun; 24(2): 173-9. doi: 10.1007/s10006-020-00838-7.
Kim HS, Chung CH, Chang YJ. Free-Flap Reconstruction in Recurrent Head and Neck Cancer: A Retrospective Review of 124 Cases. Archives of Craniofacial Surgery. 2020 Feb; 21(1): 27. doi: 10.7181/acfs.2019.00738.
Mark M, Eggerstedt M, Urban MJ, Al-Khudari S, Smith R, Revenaugh P. Designing an Evidence-Based Free-Flap Pathway in Head and Neck Reconstruction. World Journal of Otorhinolaryngology-Head and Neck Surgery. 2022 Jun; 8(02): 126-32. doi: 10.1002/wjo2.22.
Crawley MB, Sweeny L, Ravipati P, Heffelfinger R, Krein H, Luginbuhl A et al. Factors Associated with Free Flap Failures in Head and Neck Reconstruction. Otolaryngology–Head and Neck Surgery. 2019 Oct; 161(4): 598-604. doi: 10.1177/0194599819860809.
Goh CS, Kok YO, Yong CP, Tan EW, Goh LG, Chew KY et al. Outcome Predictors in Elderly Head and Neck Free Flap Reconstruction: A Retrospective Study and Systematic Review of the Current Evidence. Journal of Plastic, Reconstructive and Aesthetic Surgery. 2018 May; 71(5): 719-28. doi: 10.1016/j.bjps.2017.12.011.
Goel AN, Raghavan G, St John MA, Long JL. Risk Factors, Causes, And Costs of Hospital Readmission After Head and Neck Cancer Surgery Reconstruction. Journal of the American Medical Association Facial Plastic Surgery. 2019 Mar; 21(2): 137-45. doi: 10.1001/jamafacial.2018.1197.
Hamoir M, Schmitz S, Suarez C, Strojan P, Hutcheson KA, Rodrigo JP et al. The Current Role of Salvage Surgery in Recurrent Head and Neck Squamous Cell Carcinoma. Cancers. 2018 Aug; 10(8): 267. doi: 10.3390/cancers10080267.
Zimmer DI, Lamarre E. Free Flap Reconstruction of Skull Base Defects. Cerebrospinal Fluid Rhinorrhea-E-Book: Comprehensive Guide to Evaluation and Management. 2023 Jan: 276. doi: 10.1016/B978-0-323-87072-6.00046-6.
Largo RD and Garvey PB. Updates in Head and Neck Reconstruction. Plastic and Reconstructive Surgery. 2018 Feb; 141(2): 271e-85e. doi: 10.1097/PRS.0000000000004070.
Thariat J, Carsuzaa F, Beddok A, Deneuve S, Marcy PY, Merlotti A et al. Reconstructive Flap Surgery in Head and Neck Cancer Patients: An Interdisciplinary View of the Challenges Encountered by Radiation Oncologists in Postoperative Radiotherapy. Frontiers in Oncology. 2024 Apr; 14: 1379861. doi: 10.3389/fonc.2024.1379861.
Schutte HW, Heutink F, Wellenstein DJ, van den Broek GB, van den Hoogen FJ, Marres HA et al. Impact of Time to Diagnosis and Treatment in Head and Neck Cancer: A Systematic Review. Otolaryngology–Head and Neck Surgery. 2020 Apr; 162(4): 446-57. doi: 10.1177/0194599820906387.
Mody MD, Rocco JW, Yom SS, Haddad RI, Saba NF. Head and Neck Cancer. The Lancet. 2021 Dec; 398(10318): 2289-99. doi: 10.1016/S0140-6736(21)01550-6.
Zebolsky AL, Patel N, Heaton CM, Park AM, Seth R, Knott PD. Patient-Reported Aesthetic and Psychosocial Outcomes After Microvascular Reconstruction for Head and Neck Cancer. Journal of the American Medical Otolaryngology–Head and Neck Surgery. 2021 Dec; 147(12): 1035-44. doi: 10.1001/jamaoto.2021.1563.
Russell J, Pateman K, Batstone M. Donor Site Morbidity of Composite Free Flaps in Head and Neck Surgery: A Systematic Review of the Prospective Literature. International Journal of Oral and Maxillofacial Surgery. 2021 Sep; 50(9): 1147-55. doi: 10.1016/j.ijom.2020.12.009.
Gabrysz-Forget F, Tabet P, Rahal A, Bissada E, Christopoulos A, Ayad T. Free Versus Pedicled Flaps for Reconstruction of Head and Neck Cancer Defects: A Systematic Review. Journal of Otolaryngology-Head and Neck Surgery. 2019 Jan; 48(1): 13. doi: 10.1186/s40463-019-0334-y.
Marchi F, Iandelli A, Pace GM, Bellini E, Tirrito A, Costantino A et al. Surgical Outcomes of Profunda Artery Perforator Flap in Head and Neck Reconstruction: A Systematic Review and Meta‐Analysis. Head and Neck. 2025 Jan; 47(1): 98-111. doi: 10.1002/hed.27891.
Abouyared M, Katz AP, Ein L, Ketner J, Sargi Z, Nicolli E et al. Controversies in Free Tissue Transfer for Head and Neck Cancer: A Review of the Literature. Head and Neck. 2019 Sep; 41(9): 3457-63. doi: 10.1002/hed.25853.
Sattar T, Nazir I, Jabbar M, Malik J, Afzal S, Hanif S et al. Current Innovations in Head and Neck Cancer: From Diagnostics to Therapeutics. Oncology Research. 2025 Apr; 33(5): 1019. doi: 10.32604/or.2025.060601.
Molteni G, Gazzini L, Sacchetto A, Nocini R, Comini LV, Arietti V et al. Mandibular Reconstruction in Head and Neck Cancer: Which Is the Gold standard? European Archives of Oto-Rhino-Laryngology. 2023 Sep; 280(9): 3953-65. doi: 10.1007/s00405-023-08050-5.
Haribhakti VV. Restoration, Reconstruction and Rehabilitation in Head and Neck Cancer. Springer. 2019 Jun. doi: 10.1007/978-981-13-2736-0
Kwon D, Genden EM, de Bree R, Rodrigo JP, Rinaldo A, Sanabria A et al. Overcoming Wound Complications in Head and Neck Salvage Surgery. Auris Nasus Larynx. 2018 Dec; 45(6): 1135-42. doi: 10.1016/j.anl.2018.03.008.
Riechelmann H, Dejaco D, Steinbichler TB, Lettenbichler-Haug A, Anegg M, Ganswindt U et al. Functional Outcomes in Head and Neck Cancer Patients. Cancers. 2022 Apr; 14(9): 2135. doi: 10.3390/cancers14092135.
Lindeborg MM, Sethi RK, Puram SV, Parikh A, Yarlagadda B, Varvares M et al. Predicting Length of Stay in Head and Neck Patients Who Undergo Free Flap Reconstruction. Laryngoscope Investigative Otolaryngology. 2020 Jun; 5(3): 461-7. doi: 10.1002/lio2.410.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Pakistan Journal of Health Sciences

This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access journal and all the published articles / items are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments