Aim: Reconstruction is a big challenge. The reconstructive surgeon has to restore defect with best aesthetic and function. In recent times the high success rate of free flap has made the large defect reconstruction a possibility. To assess and evaluate the clinical outcomes in patients undergoing free flap and local flap reconstruction.

Methods: This was a retrospective study of 53 patients undergoing reconstructions with free flaps (31) and local flap (22) from June 2015 to June 2017. Types of free flap performed were Anterolateral Thigh, Radial Forearm and Fibula. Types of local flap performed were Pectoralis Major Myocutaneous flap, Deltopectoral flap, Nasolabial flap, forehead and scalp flap. Patient data was collected and analyzed for flap survival, complication, operative time, functional and oncological outcomes.

Results: The patients included 35 males and 17 females, with a mean age of 42 years. The most common tumor location was the Buccal mucosa. The majority of the diagnosed tumors were Squamous cell carcinoma. Overall flap success rate for free flap was 88% and for local flap/pedicle flap was 100%. Venous thrombosis was the most common cause for re–exploration in free flaps. The most common complication was oro–cutaneous fistula in both local/pedicle and free flaps. The average operating time for free flap was 7hr 30mins (simultaneously harvesting the graft) and for local flap was 5hr 50mins. Local flaps are economical than free flap. The most important advantages with free flap are replacement of bone tissue and reconstruction of large defects. Middle third mandibular resection has no better substitute than free fibula graft.

Conclusion: Free flap is a reliable, feasible and easy method in reconstruction of large defect with good aesthetic and functional outcome. Local flap is effective in smaller defects but cannot replace bony tissue.