Usefulness of supraclavicular flap in reconstruction following resection of oral cancer

Objective: To evaluate the usefulness of supraclavicular artery flap in reconstruc-tion of defects following resection of buccal mucosa cancer. Methods: Twenty-five patients who presented to R.L Jalappa Hospital and Research centre and diagnosed as squamous cell carcinoma of buccal mucosa staged T2 and above were included in our study. All patients underwent wide excision of tumour and neck dissection. Six patients un-derwent hemi-mandibulectomy while 4 patients underwent marginal mandibulectomy depend-ing on extent of the tumour along with neck dissection. The defect following surgery was reconstructed using the supraclavicular artery flap and were followed up for minimum 6 months during which they were assessed for the functional and aesthetic outcome using a scoring system. The details of the scoring system comprised of 7 attributes. Each attribute was given a score of 10 if the patients experienced that attribute, while a score of 0 was given if the patient did not experience that particular attribute. Results: Seven (28％) patients had complete necrosis of the flap. One patient had a local recur-rence 2 months following surgery and was lost to follow up. The remaining 17 patients were followed up for a minimum of 6 months and a scoring system was adopted to evaluate the func-tional and aesthetic outcome of the supraclavicular flap. We observed that 14 patients had an excellent outcome score (58％), 3 patients had a good outcome score (13％), while 7 patients (28％) had flap necrosis.Conclusions: We find the supraclavicular flap to be safe, technically simple, sensate, thin, pliable and reliable regional fasciocutaneous flap in reconstructing intra oral defects. Preser-ving the external jugular vein and sacrificing supraclavicular nerves give good outcome.

Clinicopathological study of surgical margins in squamous cell carcinoma of buccal mucosa

Objective:To evaluate the margins of resected specimen of oral squamous cell car-cinoma (SCC) and to document the surgical margin (measured at the time of resection) and margins at the time of pathological examination (after immersion of the specimen in formalin). Methods:Patients who were diagnosed and confirmed with squamous carcinoma of buccal mu-cosa were included in the study. Patients underwent resection of the tumor with a margin of 1 cm. Soon after resection, the distance between outermost visible margin of the tumor and the margin of the specimen was measured and documented. Specimens were fixed in 10%formalin and submitted for gross and histopathological examination. The closest histopatho-logic margin was compared with the in situ margin (10 mm) to determine and document any shrinkage of the margin and the percentage of discrepancy if any. Results: A total of 52 specimens were collected from patients between January 2014 and December 2014. All specimens were obtained from the oral cavity (n Z 52) of which 43 (82.7%) were squamous cell carcinoma and 9 (17.3%) were verrucous variant of squamous cell carcinoma. The average decrease in tumor margins measured after fixation in formalin wasfound to be statistically significant (P<0.05) in 65%of cases. Conclusion:Tumor margin shrinks significantly after formalin fixation by about 25%. The oper-ating surgeon and pathologist should be well aware of such changes while planning for further management thereby ensuring adequate margin of resection and adjuvant treatment wherever required to prevent possible local recurrence of the disease. Copyright a 2016 Chinese Medical Association. Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).