Oral cavity reconstruction over a 30-year period at a dedicated tertiary head and neck cancer centre

There are around 2,500 new cases of oral cavity squamous cell carcinoma (OSCC) reported yearly within Australia. Resection often leads to substantial defects, requiring complex reconstruction. The aim of this study was to examine how reconstruction at a dedicated head and neck cancer unit has evolved over a 30-year period. A retrospective review was conducted of all OSCC carcinoma cases performed from 1988 to 2017. Data was analysed in six-time periods; pre-1995, 1995–1999, 2000–2004, 2005–2009, 2010–2014, and 2015 and above. A total of 903 patients were identified, of which 56.1% (n = 507) underwent free flap reconstruction including 426 (84.0%) soft tissue free flaps (STFF) and 81 (16.0%) bony free flaps (BFF). STFF usage remained stable over time. The radial forearm was the most common free flap but declined over time with increasing use of the anterolateral thigh flap. The number of BFF increased from 5.0% before 1995 to 20.4% in 1995–2015. The tongue was the most common subsite, followed by the floor of mouth. Free flaps were utilised in more than 50% of OSCC reconstructions at each time period. Over time, the proportion of different STFF evolved towards increased use of the ALT flap and BFF within our institution. Level of evidence: Level four.