Does the timing of oral feeding affect the fistulization risk among head and neck cancer patients undergoing free flap reconstruction?

There is a misconception that early initiation of oral feeding protocols following head and neck reconstruction surgeries exerts stress on the sutures, predisposing the patients to a higher risk of postoperative fistula 1 Guidera A.K. Kelly B.N. Rigby P. MacKinnon C.A. Tan S.T. Early oral intake after reconstruction with a free flap for cancer of the oral cavity. Br J Oral Maxillofac Surg. 2013; 51: 224-227https://doi.org/10.1016/j.bjoms.2012.06.005 Google Scholar . This is especially of concern among head and neck cancer patients who received preoperative radiotherapy, as irradiation hinders healing. It is a proven fact that these patients are at a higher risk of postoperative fistulization, a dreaded complication following head and neck reconstructive surgery 2 Virtaniemi J.A. Kumpulainen E.J. Hirvikoski P.P. Johansson R.T. Kosma V.M. The incidence and etiology of postlaryngectomy pharyngocutaneous fistulae. Head Neck. 2001; 23: 29-33 Google Scholar . Surgeons are cautious when it comes to the timing of initiation of oral feeding postoperatively. However, this delay doesn’t necessarily benefit the patients and leads to a more extended hospital stay, which adds to the socioeconomic burden of these cancers. As a result, we conducted this meta-analysis to determine whether early oral feeding affects fistulization rates among head and neck cancer patients undergoing free flap reconstruction.