Head and Neck Cancer Reconstruction with Flap: A Comparative Study of Restoration of Internal Lining VS No Restoration

Objective: To compare surgical and functional outcomes of flap-based head and neck cancer reconstruction performed with versus without internal lining restoration. Study Design: Comparative cross-sectional studyPlace and Duration of Study: This study was conducted at the Departments of Surgical Oncology and Plastic and Reconstructive Surgery, Jinnah Postgraduate Medical Centre, Karachi from 10th November 2025 to10th May 2026. Methods: A total of 48 patients undergoing head and neck cancer resection followed by flap reconstruction were included through non-probability consecutive sampling. Patients were divided into two groups: internal lining restoration (n=24) and no internal lining restoration (n=24). Results: Patients with internal lining restoration had fewer postoperative complications than those without restoration. Wound dehiscence occurred in 2 (8.3%) versus 5 (20.8%) patients, infection in 3 (12.5%) versus 6 (25.0%), flap necrosis in 1 (4.2%) versus 3 (12.5%), and fistula formation in 2 (8.3%) versus 7 (29.2%) patients. Good surgical outcome was observed in 19 (79.2%) patients with restoration compared with 14 (58.3%) without restoration. Functional outcomes were also better in the restoration group, including good swallowing in 18 (75.0%) versus 13 (54.2%), good speech in 17 (70.8%) versus 12 (50.0%), oral feeding in 20 (83.3%) versus 15 (62.5%), and good overall functional outcome in 18 (75.0%) versus 13 (54.2%) patients. Conclusion: Internal lining restoration during flap-based head and neck cancer reconstruction was associated with lower complication rates and better functional recovery. Restoration of the mucosal lining should be prioritized whenever feasible to improve healing, swallowing, speech, and return to oral feeding.