title: Microvascular free flap reconstruction for head and neck cancer in a resource-constrained environment in rural India.
abstract: BACKGROUND
  Reconstruction with free flaps has significantly changed the outcome of patients with head and neck cancer. Microsurgery is still considered a specialised procedure and is not routinely performed in the resource-constrained environment of certain developing parts of India.
  
  
  METHODS
  This article focuses on the practice environment in a cancer clinic in rural India. Availability of infrastructure, selection of the case, choice of flap, estimation of cost and complications associated with treatment are evaluated and the merits and demerits of such an approach are discussed.
  
  
  RESULTS
  We performed 22 cases of free flaps in a six-month period (2008-2009). Majority (17) of the patients had oral cancer. Seven were related to the tongue and eight to the buccal mucosa. Radial forearm free flap (RFF: 9) and anterolateral thigh flap (ALT: 9) were the most commonly used flaps. A fibula flap (1) was done for an anterior mandible defect, whereas a jejunum free flap (1) was done for a laryngopharyngectomy defect. There were six complications with two re-explorations but no loss of flaps.
  
  
  CONCLUSIONS
  Reconstruction with microvascular free flaps is feasible in a resource-constrained setup with motivation and careful planning.
authors: Department of Plastic Surgery, Trivedi Polyclinic and Nursing Home, Mehsana, Gujarat, India ; Department of Plastic Surgery, Mazumdar Shaw Cancer Center and NH, Bangalore, India.
authors: Nirav P
authors: NP
authors: Trivedi
authors: Pravin
authors: P
authors: Trivedi
authors: Harish
authors: H
authors: Trivedi
authors: Saroj
authors: S
authors: Trivedi
authors: Nirali
authors: N
authors: Trivedi
keywords: Free flap; head and neck cancer; microvascular surgery; reconstruction; reconstruction of head and neck; resource constrained
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