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Complications in free flap #196945
08-17-2018 11:35 PM
08-17-2018 11:35 PM
Joined: Aug 2018
Posts: 1
oyishik Offline OP
oyishik  Offline OP

Joined: Aug 2018
Posts: 1
My father, aged 59 years was diagnosed with Spindle Cell (Squamous Cell) Carcinoma on his right retromolar trigone on February, 2018. It was staged at T4N1M0.
He underwent 35 sessions of Radiation (Rapid ARC), and 6 simultaneous chemo sessions weekly with Cisplatin 55mg.
After 2 months (June, 2018), regressed residual tumour was found and was thus operated on 22nd June, 2018. The discharge summary states:
Preliminary tracheostomy with wide local excision with right posterior segmental mandibulectomy with right upper alveolectomy with right ITF clearance with right modified radical neck dissection II and reconstruction with right anterolateral fasciocutaneous free flap.
He had to stay in the hospital for 3.5 weeks, during which the external swelling due to the plastic surgery had reduced a lot.
But within a week after coming back home, the areas in which the swelling had reduced started swelling up again.
After 3 days, we emailed the doctor (he is in a different city), and he suspected infection, thus suggested Tab. Augmentin 625mg.
He was taking it, and had daily sessions of mild fever. The swelling didn't increase, but started reducing very gradually.
But the main issue was right after starting the medication, the next day onwards he felt that the flap at the back of his tongue had pushed itself up a little. It also kept moving whenever he was trying to swallow. His speech became unclear, and he is almost unable to hear from his left ear (the operation was on the right side).
The doctor said it was improving, and suggested to continue the antibiotic.
He took the antibiotic for 14 days. It's the 18th day after starting the antibiotic.
The swelling has reduced in some areas, and in some other areas it is still consistent. But the major problem is with the flap which seems to be swelling up only at the back of the tongue. The rest of the tongue on his cheek is intact. Some parts of the flap is falling off when he is washing his mouth. He cannot close his mouth entirely either.
I don't know the medical terminologies, so I am unable to explain the exact positioning of the flap.
We are going to visit the doctor in 2 days. But before that, I just want to know if this is something that anyone has faced.
Is this a sign of recurrence, or some complication due to infection?
He is losing his confidence, and making me all the more anxious.

Re: Complications in free flap [Re: oyishik] #196965
08-20-2018 01:00 AM
08-20-2018 01:00 AM
Joined: Oct 2016
Posts: 15
Vishwambhar Offline
Vishwambhar  Offline

Joined: Oct 2016
Posts: 15
In my opinion this is not the sign of recurrence.Healing will take time.may be some infection due to radiation and surgery. His immunity is weak so it would take some more time to recover from normal.I had some what similar issues and osteoradionecrosis was diagnosed by the doctor due to radiation therapy as it was not healing form more than 6 months.


SCC,Left mandibles
Mandibulectomy on 17/10/2016
radical neck dissection
Cisplatin/5FU -3 cycles
35 radiation completed on Jan 2017
Re: Complications in free flap [Re: oyishik] #197007
08-23-2018 06:22 AM
08-23-2018 06:22 AM
Joined: Jun 2007
Posts: 10,197
ChristineB Offline

Administrator, Director of Patient Support Services
ChristineB  Offline

Administrator, Director of Patient Support Services
Patient Advocate (old timer, 2000 posts)

Joined: Jun 2007
Posts: 10,197
Welcome to OCF! Im very sorry to read about what your father has been thru. Im also sorry for the delay in replying!!!

As patients/survivors and caregivers we also do not always know the medical terminology. Please understand if we are not able to take the preliminary report you have provided and give you a our "expert" advice and opinions. Comparing patients is not ever an equal comparison as every single patient has their own unique body with different medical history, hereditary factors, etc. Each patient always will have their own individual reaction to medication, treatments, etc. From going thru my own medical experiences and what Ive seen others here go thru it sounds like your father still has either an infection or it could be fluid build up and swelling which is normal after what he has gone thru? These are just guesses and things like this should be brought to the doctors attention. Any type of swelling in the throat area could cause a serious medical crisis restricting his ability to breathe. With the surgery being only a short time ago, your father has a long way to go before the swelling goes away completely and he is fully recovered. It can take a patient a full year for the swelling to fully subside. Swelling will also have a major impact on his speech. Most patients who have their speech affected by surgery need help from a speech therapist to learn how best to work with their new tongue. Most will find they have significant improvement with their enunciation after working with them. Your fathers hearing can be affected by swelling too. Recovery from this sort of surgery can take a long time!!! For patients and their caregivers any recovery they are facing never will happen quickly enough. Its not easy trying to bounce back from such an invasive operation. To heal it takes a balanced diet rich in protein to help promote healing. But!!! (theres always a but!) Your father has had radiation to this area which changes his ability to heal and make his recovery much more difficult and slower. Patients that are given rads will need 2 years to make a full recovery. Since he did not have enough time to recover from the rads before he had surgery, your father definitely have more ups and downs that patients who first had their surgery then followed it with rads.

I hope after being seen by his doctor he is doing better. Make sure he has an intake of at least 2500 calories and 48-64 oz of water to help him recover every single day. Ask his doc if its ok to add high protein whey powder to boost his protein intake and hopefully help him to heal. If your father has lost weight and/or is on the average or slim side, he could need more daily calories like 3000 or even 3500 calories daily. If he has a feeding tube that would help him tremendously to take in enough calories daily. If not... ask his doc if he could have a temporary nasal tube to use until he is better able to swallow and eat on his own. Patients who have been thru things like what your father has been thru will likely have swallowing challenges. He may need to have a barium swallow test done to see if he is even capable of swallowing safely or if he is aspirating which can cause aspiration pneumonia from fluid build up in his lungs. These are more topics to bring up to his physician.

Best wishes with everything!!!

SCC 6/15/07 L chk & by L molar both Stag I, age44
2x cispltn-35 IMRT end 9/27/07
-65 lbs in 2 mo, no caregvr
Clear PET 1/08
4/4/08 recur L chk Stag I
surg 4/16/08 clr marg
215 HBO dives
3/09 teeth out, trismus
7/2/09 recur, Stg IV
8/24/09 trach, ND, mandiblctmy
3wks medicly inducd coma
2 mo xtended hospital stay, ICU & burn unit
PICC line IV antibx 8 mo
10/4/10, 2/14/11 reconst surg
OC 3x in 3 years
very happy to be alive smile

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