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Early feeding after free flap reconstruction for oral cancer


Authors: Cyrus Kerawala,Francesco Riva,Grainne Brady,Justin Roe,Lauren Leigh-Doyle
Publication: Journal of The Irish Head and Neck Society - 2023
Issue: 1 Volume: 1
Published: June, 2023 View PDF

Background: Following oral cancer resection with free flap reconstruction, patients can remain nil by mouth for up to 12 days.

Methods: A single site prospective review of an early feeding protocol in 50 consecutive patients who had free flap reconstructive surgery for oral cancer.

Results: The sample included 26 males and 24 females. Average age was 59.1 years (range: 24-88). Tumour sites included oral tongue (n=18), mandible (n=10), maxilla (n=9), floor of mouth (n=6), buccal mucosa (n=6) and retromolar trigone (n=1). Free flaps included anterolateral thigh (n=23), fibular (n=10), radial forearm (n=11) and medial sural artery (n=6). The majority (n=43) were treated for primary disease. The majority (88%) were able to tolerate oral intake by day 3 post-surgery. Intraoperative nasogastric tube (NGT) was placed in 76% (n=38). Median days to NGT removal was 4.5 (range 1-19). Median length of hospital stay was 11 days (range 3-51). Median Performance Status Scale Normalcy of Diet (PSS-NOD) score at point of hospital discharge was 40 (range 0-60). Flap failure was noted in one patient (2%).

Conclusion: Early post-operative feeding did not appear to cause any increased morbidity. A potential shorter hospital stay may encourage the adoption of an early post-operative oral feeding protocol.

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