(22) Resumption of Oral Feeding Following Reconstruction of Oral Cavity Defects: A Comparison of the Submental Artery Island Perforator Flap (SAIPF) and Radial Forearm Free Flap (RFFF)

Abstract: Purpose
To date, there does not exist a standardized algorithm for the timing of oral feeding (TOF) following oral cavity reconstructive surgery. However, several studies have shown that oral feeding within 5 days following free flap reconstruction was safe and did not result in increased complications. Oral feeding following regional flaps such as the submental artery island perforator flap (SAIPF) has not been well studied. The purpose of this study is to compare the TOF between the SAIPF and radial forearm free flap (RFFF) following oral cavity reconstruction. Length of hospitalization (LOS) and surgical site complication rates also were analyzed.

Patients and methods:
A retrospective study included patients who received a SAIPF or RFFF for oral cavity reconstruction from 2014 to 2023. Demographic, surgical, and pathology-related data were recorded. Primary and secondary outcomes included TOF postoperatively (days) and LOS (days). Linear regression analyses were used to determine predictor variables for the study outcomes. Statistical significance was set for all tests at P values of <.05.


Results:
A total of 235 patients (55, SAIPF and 180, RFFF) met the inclusion criteria for the study with a mean age of 64.24 years and a mean follow-up period of 32.91 months. Advanced age, higher American Society of Anesthesiologists (ASA) physical status score, female predilection, unilateral neck dissection, and shorter follow-up period were associated with SAIPF. TOF postoperatively was comparable between the two groups (SAIPF = 15.6 days vs. RFFF = 14 days, P = .429). Study variables associated with TOF included body mass index (BMI) (95% confidence interval (CI) = -0.570 to -0.037, P = .026), age (95% CI = 0.067 to 0.305, P = .002), and extent of neck dissection (95% CI = 0.396 to 7.671, P = .030). LOS and rate of complications were comparable between the two groups.


Conclusions:
The SAIPF remains a valuable regional flap reconstruction option for oral cavity defects and demonstrates comparable postoperative outcomes to the RFFF. Timing to oral feeding following reconstruction and complication rates were similar when compared to a vascularized free flap. In patients with advanced age, a high ASA score, and multiple medical comorbidities, the SAIPF offers an excellent reconstructive option for oral cavity defects with low morbidity.