Quality of life assessment in patients with locally advanced head and neck malignancy after ablative surgery and reconstruction with microvascular free flaps.

OBJECTIVE To assess the improvement in Quality Of Life (QOL) after ablative surgery in locally advanced head and neck malignancies by microvascular free flaps reconstruction. STUDY DESIGN Quasi-experimental. PLACE AND DURATION OF STUDY Department of Plastic Surgery, Combined Military Hospital, Rawalpindi, from September 2005 to February 2007. METHODOLOGY A total of 44 patients with locally advanced stage III and IV malignancy of head and neck were included in the study. All patients were treated with ablative surgery and reconstruction with microvascular free flaps. QOL was assessed by using a scoring questionnaire (including 5 parameters for extra oral cancers including physical and role function, body image, weight loss score and pain donor site morbidity; and an additional 5 parameters for intraoral tumours that included swallowing, speech, drooling of saliva and mouth opening). A high score indicated a poor QOL. Patients were assessed pre-operatively and then at 2, 4 and 6 months postoperatively. RESULTS Mean accumulative score and mean individual parameter scores for both extra- and intraoral tumours were significantly improved (p < 0.05). CONCLUSION Microvascular free flap reconstruction after ablative surgery in locally advanced head and neck malignancy had a profound impact on the improvement of QOL. There was an initial deterioration of physical scores postoperatively and postradiotherapy, followed by gradual improvement. By the end of 6 months, it surpassed the pre-operative QOL scores.