(A602) Postoperative Outcomes of Free Flap Repair Following Cancer Ablation of the Hard and Soft Palate

Monday, October 13, 2025

12:00 PM - 1:00 PM EDT

Location: OTO EXPO, Posters

Presenting Author(s)

Mary F. Dover

Medical Student
Wake Forest University School of Medicine
Winston-Salem, North Carolina, United States

Co-Author(s)

LG

Lilian D. Galarza Paez, n/a

Medical Student
Wake Forest University School of Medicine
Winston Salem, North Carolina, United States
Lucas A. Klever, n/a

Medical Student
Wake Forest University School of Medicine
Winston Salem, North Carolina, United States
Samuel B. Craig, BS

Medical Student
Wake Forest University School of Medicine
Winston-Salem, North Carolina, United States
Zoe-Ann V. Robertson, MD

Resident
Atrium Health Wake Forest Baptist Medical Center
Kernersville, North Carolina, United States
SI

Scott Isom, n/a

Atrium Health Wake Forest Baptist, United States
KF

Kenneth R. Feehs, MD

Resident
Wake Forest University School of Medicine
Winston Salem, North Carolina, United States
HP

Hafiz S. Patwa, MD

Academic Faculty Physician, ENT/Head and Neck Surgery, Head and Neck Oncology
Wake Forest University
winston Salem, NC, United States
JW

Joshua D. Waltonen, MD

Associate Professor
Wake Forest University School of Medicine
Winston-Salem, North Carolina, United States
CS

Christopher A. Sullivan, MD

Wake Forest University School of Medicine, United States
JB

J. Dale Dale Browne, MD

Chair, Professor
Wake Forest University School of Medicine
Winston Salem, NC, United States

Senior Author(s)

AS

Allison A. Slijepcevic, MD

Assistant Professor, Otolaryngology
Atrium Wake Forest Baptist Medical Center, United States

Disclosure(s):

Mary F. Dover: No relevant relationships to disclose.

Samuel B. Craig, BS: No relevant relationships to disclose.

Zoe-Ann V. Robertson, MD: No relevant relationships to disclose.

Kenneth R. Feehs, MD: No relevant relationships to disclose.

Introduction: Surgical repair of palate cancer defects is complex due to the palate’s role in speech and swallowing, often necessitating free flap reconstruction. This study aims to identify risk factors for adverse postoperative outcomes and optimal flap types for palate repair.

Methods: Retrospective chart review of postoperative outcomes in patients who underwent free flap reconstruction of the hard and/or soft palate at Atrium Health Wake Forest Baptist from 2010 to 2020. Independent variables include past medical history and operative characteristics.

Results: 111 patients were included: 40 (36%) female and 71 (64%) male. Free flap types: 48 (43%) radial forearm, 41 (37%) parascapula, 14 (13%) scapula, and 8 (7%) others. 55 (50%) patients demonstrated postoperative complications: 24 (22%) dehiscence, 18 (16%) fistula, and 15 (14%) infection. G-tube dependence was observed in 28 (25%) patients. Free flap revision was required in 21 (19%) cases, and 5 (5%) flaps failed. Alcohol use was associated with a higher rate of all-cause postoperative complication (RR: 1.63, 95% CI: 1.01-2.89, p=0.045), particularly fistula development (RR: 1.29, 95% CI: 1.05-1.77, p=0.018). The risk of postoperative wound dehiscence was 1.4 times higher in stage T4 tumors compared to non-staged tumors (95% CI: 1.10-1.93, p=0.005). A history of cardiopulmonary disease was also linked to increased wound dehiscence. Flap type did not significantly impact postoperative outcomes.

Conclusions: Palate cancer defects can be successfully repaired with multiple free flap types though complication rates remain high. Additional intra-operative precautions should be taken to avoid post-operative dehiscence and fistula development in patients with a history of alcohol use, cardiopulmonary disease, or advanced-stage tumors.