(0687) Near Immediate Feeding After Free Flap Reconstruction: A Descriptive Study Suggesting Safety and Efficacy

Introduction: The optimal timing of oral feeding after free tissue transfer remains a controversial topic, with “early feeding” arbitrarily considered to be postoperative day (POD) 5. The purpose of this study is to highlight the effects of near immediate feeding after free flap reconstruction on postoperative fistula rate and feeding outcomes.

Methods: A retrospective cohort study was performed at a tertiary care center for patients undergoing free flap reconstruction of mucosalized head and neck defects. In 2023-2024, 7 patients underwent near immediate feeding after surgery (within 1-3 days). Primary outcomes were incidence of salivary fistula. Secondary outcomes included functional oral intake scores (FOIS), length of stay (LOS), and QOL measures. The study’s data collection is still ongoing with an anticipated larger patient cohort at time of presentation.

Results: Thus far, 7 patients have been offered near-immediate water and ice chips. All patients had oral cavity defects, with the majority reconstructed with osseocutaneous fibular free flap (66.7%). All started oral feeding on POD 1-3 (1: 42.9%, 2: 14.3%, 3: 42.9%) and advanced to a full liquid diet. The average LOS was 6.1 days (SD: ±1.07). Only 1 patient had an orocutaneous fistula postoperatively. All observed patients had their feeding tube removed prior to discharge and achieved a FOIS score of 4 or more.

Conclusions: Development of a fistula, which has a reported incidence ranging from 9 to 25%, is a known predictor of worsening LOS and delaying time to adjuvant radiation. For these reasons, the traditional approach to feeding after free flap reconstruction includes a period of alternative enteral nutrition ranging from days to weeks. The observed population suggests that near immediate or early oral feeding after free flap reconstruction can occur without worsening salivary fistula rate. Additionally, the present analysis describes reasonable LOS and functional swallowing outcomes after early feeding. This study adds to the growing literature aimed to optimize safe swallow after free tissue transfer, without compromising the rate of fistula formation.