Availability of Plastic and Reconstructive Services (PRS) for Head and Neck Reconstruction with Free Flaps (FF) Following Oncological Resection in India-A Reality Check.

Abstract

Head and neck cancer is among the most common cancers in India. Most of these patients present with advanced disease requiring extensive surgical resection and appropriate reconstruction. Though the expertise for surgical resection may be available, the same for reconstruction, especially microvascular reconstruction, may not always be available. We included centres that were members of National Cancer Grid (NCG) and institutes that offered academic programs such as the M.Ch, DNB (Surgical Oncology and Head and Neck Surgery), FNB (Head and Neck Oncology), and Fellowships (Head and Neck) across the country. After identifying the centres, we analysed how many of these centres had a department of Plastic and Reconstructive Surgery (PRS) and whether they offer reconstructive services, including microvascular free flaps. Three hundred and sixty-eight centres were identified across India. One hundred and eighty-eight centres (46%) had a PRS department, most of them were in the south zone (n = 57/90, 63.3%) and north zone (n = 33/65, 60%) (p < 0.001), in private centres (n = 135, 58.9%) (p < 0.001), in tier 1 cities (n = 58/100, 58%) (p < 0.001), and centres with active academic programs (p < 0.001). Out of 188 centres, 166 performed microvascular free flaps (MFF). In a few centres, reconstruction was done by surgeons who performed the resection of the cancer (n = 54, 14.6%). Overall, MFF was performed in 57.2% of hospitals across the country. There is a reasonable number of centres with PRS services available in the country for oncoreconstruction. However, their distribution seems to be skewed, with more of them located in private institutions/centres and tier 1 cities.