Evaluation of the Interest of the Neurorrhaphy in Resensitizing Free Flaps
Evaluation of the Interest of the Neurorrhaphy in Resensitizing Free Flaps
The surgical procedure consists in removing a tumor of the oral cavity and then repairing the
 oral defect by the use of a free flap. A free flap is tissue composed of skin and aponeurosis
 taken from the thigh or forearm, or tissue composed of bone taken from the leg to fill in
 tissue loss. This tissue is vascularized by a vein and an artery that are removed with the
 flap to ensure its survival. Investigator would also like to harvest the nerve involved in
 the sensitivity of the skin flap to suture it to a nerve which will be located near the
 reconstructed area, and this to enhance sensitivity of the reconstructed oral cavity. Thanks
 to this, investigator also wish to highlight that this resensitization would improve the
 patient's quality of life particularly regarding his major oral functions (swallowing,
 phonation, sensation of cold and hot felt, chewing).

 Investigator therefore seek to demonstrate that suturing the nerve will give to the patient
 the ability back to feel tactile and thermal sensations This is the purpose of the study.
Investigator will compare patients in whom the nervous suture will be performed and patients
 in whom it will not. If a significant difference in oral sensitivity is noted between these 2
 groups, investigator can support our thesis: suturing the flap nerve increases its ability to
 regain sensitivity.

 All patients are first diagnosed in consultation and presented at a carcinologic
 multidisciplinary consultation during which an individually adapted treatment is proposed
 (according to the French "Plan Cancer"). If it consists in a surgery with reconstruction
 using free flap technique at the same time, Investigator then propose to the patient to
 integrate our study. The possibility to participate to this study is therefore proposed to
 the patient on the same day that the plan of treatment is presented. The patient has a period
 of reflection, minimal time necessary to mature his reflection and make their choice with
 their loved ones and decide if they agree to participate to the study. His answer is required
 the day before the surgery. This represents a reflection period of two weeks on average. If
 he accepts it, computer software (RedCap®) will determine at random if the surgical team will
 perform a nervous suture or not. As a result, two groups patients are then created: one with
 nervous suture and one with no nervous suture. By comparing these two groups, investigator
 hope to demonstrate that there will be more patients with a flap sensitive in the "with nerve
 suture" group than in the "without nerve suture" group.

 Investigator will then collect data from tests and questionnaires allowing us to judge the
 resensitization of the flap during follow-up consultations at 3, 6 months then at 1 year
 postoperatively in parallel follow-up consultations. That is to say that the patient
 therefore comes for a consultation as part of his cancer follow up and investigator take
 advantage of this time to carry out tests and questionnaires. This adds about 20 minutes of
 consultation time.

 A preoperative evaluation will be done before the surgery corresponding to the basal state
 calibration. During these consultations, investigator perform two tests and investigator will
 provide 2 quality of life questionnaires to fill out:

 -  The two-discriminating points test: two points are applied on the flap at different
 distances and the patient must indicate if he feels one or two points.

 -  The hot/cold test: hot water and cold water are applied on the flap separately, and the
 patient should indicate if he feels the temperature differences.

 -  The QLQ-C30 and EOTRC H&N 35 questionnaires: several questions concerning the quality of
 life are asked to the patient who must answer them as honestly as possible.

 After collecting all this information, investigator can compare the sensitivity of free flaps
 with or without nerve suture.

 In parallel, investigator will also evaluate the economic impact and cost that this can
 represent by comparing the operating and hospitalization times of patients in each group.
 Investigator believe that the operating time is not increased nor the length of
 hospitalization and therefore that there is no additional cost.
Inclusion Criteria:

 -  - Patient eligible for reconstructive surgery after carcinological excision following
 a decision taken in a multidisciplinary consultation, and for whom the envisaged oral
 defect concerns either the soft tissues of the oral cavity and oropharynx, or the
 mandibular bone

 -  Scheduled post-operative radiotherapy

 -  Coverage by the Social Security system

 -  Capacity to provide informed consent

 Exclusion Criteria:

 -  Post-traumatic substance loss (ballistic autolysis)

 -  Surgical or anesthetic contraindication (physiological age, other proposed therapeutic
 options)

 -  Pregnant or breastfeeding woman

 -  Subject incapable of full age or deprived of liberty

 -  Indication for chemotherapy with highly neurotoxic agents

 -  Inability to complete questionnaires or express feelings during the examination

 -  Any situation judged by the investigator as a contraindication to neurorrhaphy