Background: Microvascular free flap surgery for  reconstruction of head and neck region in surgical ablation of cancer cases has gained tremendous advancement and interest of oncology and plastic surgeons in recent few years as a sophisticated surgical procedure. This study was conducted at our center to evaluate the patient demographics, determine risk factors on outcome of surgery and complications related with the commonly used free flaps for head and neck reconstruction at our center. 

Methods: This prospective clinical study was conducted in JSS hospital for duration of 3 yrs between January 2013 and December 2016. Free flaps used at our center, i.e. free radial artery forearm flap (FRAFF), free fibular osseocutaneous flap (FFOCF) and free anterolateral thigh flap (FALT) were considered for the study. 

Results: This study included 43 patients with oral cavity cancer, of which 36 were males and 7 females, with a mean age of 39.8 yrs. Tobacco consumption was seen in staggering more than 90% of cases with most common primary tumor site being buccal mucosa (27.9%), and squamous cell carcinoma being most common cancer type in 88% of the study cases. FRAFF was the most common flap used for reconstruction in 67% of cases with overall flap loss being in 20%. Recurrence was recorded in 20.9% of cases with a minimum follow up of 6 months but no mortality was noted during the study period. 

Conclusion: This study emphasizes that free flaps are ideal for good cosmetic and functional outcome in reconstruction of oral cavity. Among the flaps used in our study, FRAFF is safe, reliable, and versatile. In mandibulectomy cases, FFOCF is ideal but technically more demanding and needs more expertise to improve the outcome and success rate. We would like to conclude that we need to hone our surgical skills and technique to improve the outcome of free flaps with proper flap selection accordingly, adequate preparation and isolation of reliable recipient vessels and good surgical technique.

Keywords: Oral Cavity; Cancer; Reconstruction; Free flap; Free Radial Artery Forearm Flap; Free Fibular
Osteocutaneous Flap; Free Anterolateral Thigh Flap.