**Abstract**

The treatment of the oral cancer is complex in terms of resection and reconstruction. Adequate multidisciplinary approach is needed to plan the oncological resection and functional reconstruction to obtain optimal results and adequate rehabilitation of the patient. Many factors should be considered in order to reconstruct the surgical defects, including patient factors, the expertise of the team, and other tumor and defect factors. Early cancer and its subsequent defects can be reconstructed merely with a primary closure or a skin graft, but as soon as the cancer stage worsens, the devastation of primary tumor is bigger needing a more complex surgery and skilled reconstructive techniques to implant a new safe tissue, starting from a local flap, a pediculate flap, and up to a free composite flap. Nowadays there is a trend to perform microvascular free flaps in most of the reconstructions, but if a rational approach is planned, even in the most advanced cases, it can be solved with locoregional flaps, limiting the need of a microvascular surgery and its subsequent overcost in care and special skills in reconstruction. This chapter pretends to give a rational approach to get that goal.

**Keywords:** oral cancer, head and neck reconstruction, local flaps, pediculate flaps, free flaps

### **1. Introduction**

One of the most common cancers of the head and neck region is the oral cavity cancer. Globally, over 300,000 people are diagnosed with oral cancer each year, being the eight most common cause of malignancy [1]. In early stages, a cure is possible with minimum morbidity; unfortunately, such disease is not usually diagnosed until it has set to an advanced stage impacting survival, including in that stage morbidity due to tumor invasion or tissue devastation, and its consequent treatment negatively impacts the quality of life [2]. With that in mind, every effort must be done to reconstruct the defect of the primary resective procedure in order to restore swallowing, speech, esthetics, and color match, among others. A complete evaluation must be done to define the optimal reconstruction without compromising the oncological resection and first of all evaluating each patient in terms of age, functional capacity, adjuvant therapies, airway protection, survival, etc. There are many options to reconstruct the defect, so a comprehensive approach should be planned, principally considering its location in the oral cavity, the size of the anatomical structure resected, as well as the consequence of the

defect that may affect a complex functional unit that could include the mucosa, muscle, bone, skin, or a combination of them, which additionally may develop a continuity solution that creates a communication between the oral cavity with the neck and its subsequent salivary fistula, infection, risk of a major vessel blood bleeding or carotid blowout, and death. The reconstruction might be done just with a primary closure and skin graft or may be left to heal by second intention with no closure; some cases will need a pediculate, local, or regional flap, and in complex and huge defects, a microvascular free flap might be needed. Currently there is a trend to perform a microvascular reconstruction for most of the defects, but even in a two-team approach, the microvascular reconstruction increases the cost and duration time of the surgery; furthermore some health centers lack surgeons with the necessary skills to perform a microvascular surgery. The purpose of this chapter is to review the state of art in oral cavity reconstruction after an oncological resection and especially provide a rational approach to reconstruct each defect in order to restore it as similar as normal tissue before resection, discussing pros and cons of reconstruction.
