Surgical Lip Cancer Reconstruction in the COVID-19 Era: Are Free Flaps or Loco-Regional Flaps Better?

Round 1

Reviewer 1 Report

Although the number of cases is small, it is a very meaningful paper that describes treatment methods during the spread of COVID-19 infection.

This is a paper on surgical treatment options due to the spread of COVID

-19 infection. The problem with this paper is the small number of cases 

(increase the number of cases if possible). However, the topic of the 

paper is very important and should be published. However, it is 

necessary to describe the general surgical method for malignant tumors 

on the lips in the discussion.. 

Author Response

Dear reviewer,

Thank you for the attention you reserved for our manuscript.
As requested, a paragraph was added in the discussions where reconstructive strategies are evaluated according to the location and extent of the primary tumor.

I apologize for the delay.    Kind regards,  

David GUIDA - MD

Cranio-Maxillo-Facial Surgery

Multidisciplinary Department of Medical-Surgical and Dental Specialties

University of Campania "Luigi Vanvitelli"

Via L. De Crecchio 6, 80138 Naples, Italy

[email protected]

[email protected]

+393200409104

Reviewer 2 Report

Well written and interesting case series. 

Author Response

Dear reviewer,

Thank you for the attention you reserved for our manuscript.

Kind regards,  

David GUIDA - MD

Cranio-Maxillo-Facial Surgery

Multidisciplinary Department of Medical-Surgical and Dental Specialties

University of Campania "Luigi Vanvitelli"

Via L. De Crecchio 6, 80138 Naples, Italy

[email protected]

[email protected]

+393200409104

Reviewer 3 Report

The authors performed a retrospective analysis of lip cancer surgical defect reconstructed with free or regional/local flaps. The topic fits into this journal readership. The paper is well written with some improvement needed in certain area as highlighted below:

1.       RFFF abbreviation was used in abstract without prior explanation what it meant

2.       English needs to be looked at by native speaker

3.       I believe the aim should be not to “evaluate” but to “compare” the available reconstructive 62 surgical options for the treatment of lip carcinomas in order to define which could be the most appropriate, cost-effective and time sparing …. (line 62 to 65)

4.       Table 2, 3 and 4 can actually be made into one table. Kindly combine those table

5.       Results chapter 3.5 regarding aesthetic and functional outcome is not scientific. This is empirical argument only by the authors. This part should be deleted. Should not be part of a scientific publication. Unless there are more objective ways to compare/assess these parameters.

6.       Size of tumour (mean size of regional flaps versus Free flaps) should be reported and statistically analysed.

Author Response

Dear reviewer,

Thank you for the attention you reserved for our manuscript.
As requested, I made the necessary corrections:

1. The abbreviation RFFF has been removed from the abstract.
2. English has been reevaluated in the manuscript.
3. The change request on the correct aim of the study was evaluated and accepted and then modified (Line 67).
4. Tables 2, 3 and 4 were unified.
5. Section 3.5 was removed.
6. Tumor size is analyzed in detail in Table 1, and in detail a section has been added where the reconstructive choice and strategy changes between the pre-pandemic period and the period under study in our study are evaluated.

I apologize for the delay.    Kind regards,  

David GUIDA - MD

Cranio-Maxillo-Facial Surgery

Multidisciplinary Department of Medical-Surgical and Dental Specialties

University of Campania "Luigi Vanvitelli"

Via L. De Crecchio 6, 80138 Naples, Italy

[email protected]

[email protected]

+393200409104

Round 2

Reviewer 3 Report

The authors has improved the manuscript with the corrections made. I still believe a statistical analysis should be made to compare the size of the lesion with the choice of reconstruction (fee flap vs regional flap). Ideally the mean size of the tumour should be compared between the two groups. If this is not possible, the T staging can be used (albeit it will be categorical data analyses). Table 1 did report the TNM staging but comparison between group is what is more important. we want to know if the tumour size did effect the decision in reconstructive options (in the COVID era)

Author Response

Dear Reviewer,

The tumor mean size of the RFFF group was 49,4mm±4,5mm and of the local flap group was 42,2±7,6mm. Statistically evaluating the size of tumor lesions, they do not live statistically significant differences between the two groups (p value 0.021) considering the reconstructive choice to be performed.

Kind regards,  

David GUIDA - MD