Versatility and Reliability of Islanded Pedicled Nasolabial Flap in Head and Neck Cancer Reconstruction

Objectives Reconstruction of head and neck cancer ablative defects is challenging. A modification of the nasolabial flap (islanded pedicled nasolabial flap [ipNLF]) is an easy and reliable option for reconstruction of small‐ to medium‐sized defects of the head and neck, especially in resource‐constr...

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Published in:The Laryngoscope 2020-08, Vol.130 (8), p.1967-1972
Main Authors: Chakrabarti, Swagnik, Gupta, Devendra Kumar, Gupta, Monika, Daga, Dipti, Mishra, Aseem, Sharma, Sudhendu Shekhar, Chugh, Rajeev, Singh, Sanajeet Kumar
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Defects
Female
Fistula
Head & neck cancer
Head and Neck Neoplasms - surgery
Humans
ipNLFfunctional outcomecomplications
Lip - transplantation
Male
Middle Aged
Nose - transplantation
Postoperative Complications - epidemiology
Reconstructive Surgical Procedures - methods
Retrospective Studies
Surgical Flaps
Tracheotomy
Wound dehiscence
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Summary:Objectives Reconstruction of head and neck cancer ablative defects is challenging. A modification of the nasolabial flap (islanded pedicled nasolabial flap [ipNLF]) is an easy and reliable option for reconstruction of small‐ to medium‐sized defects of the head and neck, especially in resource‐constrained and high‐volume centers. Study Design and Methods We present the retrospective analysis of 27 consecutive patients reconstructed with ipNLF at two high‐volume cancer centers, Homi Bhabha Cancer Hospital, Varanasi, India; and Army Hospital Research and Referral, New Delhi, India. The functional outcomes measured were duration of weaning of feeding and tracheotomy tubes and speech assessment (speech intelligible rating score [SIR]) postsurgery. Complications assessed were flap loss, orocutaneous fistula, donor site wound dehiscence, oral incompetence, and angle of mouth deviation. Results The most common ablative defect was of the oral cavity (22 patients), followed by the oropharynx (4 patients) and hypopharynx (1 patient). The mean operating time for flap harvesting and insetting was 57.7 minutes. The mean durations for postoperative feeding tube and tracheotomy removal were 10 and 5 days, respectively. Twenty‐four subjects had SIR scores of I or II. None of the subjects had flap loss, orocutaneous fistula, or donor site wound dehiscence. Twenty‐five subjects had no oral incompetence, and 26 subjects had no or minimal angle of mouth deviation. Conclusion This is the largest series of ipNLF to date and emphasizes the versatility, reliability, reproducibility and excellent functional and acceptable cosmetic outcomes of this flap for the reconstruction of judiciously chosen head and neck ablative defects. Level of Evidence 2C Laryngoscope, 130: 1967–1972, 2020
ISSN:0023-852X
1531-4995
DOI:10.1002/lary.28662