ABSTRACT INTRODUCTION- Small to moderate sized soft tissue defects of the oral cavity after tumor resection involving tongue, buccal mucosa, floor of mouth require complex reconstruction with a pliable soft tissue bulk and lining epithelium. Free microvascular tissue transfer in the form of radial forearm flap, anterolateral thigh flap or others is required in such cases as ideal tools of reconstruction. The conventional alternative options are primary closure and other workhorse flaps like pectoralis musculocutaneous, deltopectoral, forehead flaps. Hence in small to moderate defects of the oral cavity, when options of higher or extensive reconstructions are not available due to lack of infrastructure or finance, locoregional pedicled tissue transfer like the nasolabial flap provides an excellent alternative. AIMS AND OBJECTIVES- , To evaluate the one stage pedicled nasolabial flap as a viable option of reconstructing versatile, small to medium sized (upto 6cm) soft tissue intra-oral defects following resection of tumors as an alternative to free microvascular tissue reconstruction. METHODOLOGY- In this retrospective, descriptive, purposive, non-randomised study with convenience sampling, patients with Stages I, II and III oral CA involving tongue, buccal mucosa, floor of mouth and gingivobuccal sulcus aged between 20 to 70 years were included in this study, who were counselled, informed consents taken, pre anaesthetic check up done and operated with single stage nasolabial flap with primary closure of the donor site. They were postoperatively monitored for complications and flap viability, discharged and followed up regularly at OPD. RESULTS- Over a study period of 1 year, we operated on 12 patients with intraoral malignancies for whom the post tumor ablative defects were reconstructed with the single-stage nasolabial flap. The site of tumor was tongue in 50% cases, buccal mucosa in 25%, floor of mouth in 16.67%, gingivobuccal sulcus in 8.33% cases. The mean size of defect created after excision of tumor was 5.0x2.92 cm length and breadthwise. Out of 12 flaps 11 flaps survived with excellent results in functional and anatomical restoration of oral cavity in the long term follow up. CONCLUSION- In a developing country with financial constraints, increased patient load and scarcity of resources for higher forms of microvascular free tissue transfer, the one stage pedicled nasolabial flap forms a viable option of reconstructing versatile, small to medium sized (upto 6cm) soft tissue intra-oral defects following resection of tumors with an acceptable donor site scar, functions of deglutition, mastication and speech and simplicity of the procedure without a steep learning curve. Also the flap provided an excellent pliable soft tissue cover which can withstand post- operative radiotherapy well. ORIGINAL RESEARCH PAPER Plastic Surgery Evaluating the One-stage Islanded Pedicled Nasolabial Flap as an alternative to Free Microvascular Tissue Reconstruction in Composite Soft Tissue Intra-oral Defects in a Developing Country- A Retrospective Study in a Tertiary Government Hospital. KEY WORDS: one stage nasolabial flap, oral reconstruction. INTRODUCTION Oral malignancy involving the tongue,floor of mouth and buccal mucosa entails wide local excision, neck dissection and [1] reconstructionwithasoftpliabletissuewithanepitheliallining . Free microvascular tissue transfer in the form of radial forearm flap,anterolateral thigh flap and others,though regarded as the gold standard of reconstruction now, is not feasible in all cases especially in developing countries where there are financial constraints,lack of infrastructure and willingness to take the risk of failure. Also not every case would require conventional workhorse flaps like pectoralis, deltopectoral, forehead and others to reconstruct these defects. In such scenario the nasolabial flap as a means of locoregional pedicled tissue transfer provides an excellent and viable means of reconstruction. [2,3,4] The pedicled nasolabial flap is an axial flap (may be used as a random pattern also) with blood supply provided either by the angular branch of the facial artery (inferiorly based flaps) or the transverse facial artery and the infraorbital artery (superiorly based flaps). Unilateral flaps can cover defects upto 3 cm in largest dimension while larger defects upto 5 cm in largest [1] dimensionrequirebilateralflapharvest . The nasolabial crease runs obliquely from 1 cm superior to [1,3,5] lateral alar rim to 1cm lateral to corner of mouth. Facial artery lies deep to the risorius and zygomaticus major muscles but superficial to buccinators. There exist small perforators supplying the skin in the form of subdermal plexus. The flap may be used as a random pattern flap also with classical length : breadthratioof3:1.Thedonorsiteisprimarilyclosedtoorientthe resultantscarinthenasolabialcreaseline. The flap may be used as variants of advancement type,islanded pedicled transposition type, turnover type or perforator flap [3,5] according to need. The islanded perforator type is used to increase the arc of movement for reconstructing mobile structures like tongue. The flap can be superiorly or inferiorly based. In many cases it has been done without strictly incorporatingthefacialvessels. Soft tissue defects in the oral cavity which are small to medium sized in the regions of tongue (upto two third), gingivobuccal sulcus without mandibulectomy,buccal mucosa,floor of mouth [2,3] need soft tissue bulk with lining epithelium. The nasolabial flapcanbeusedtotailorsuchcomplexreconstructiontoprovide anatomical restoration of the structures needed for essential functionsofmastication,deglutitionandspeech. METHODOLOGY Over 1 year (August, 2017 to July 2018) we operated on oral Jayesh Kumar Jha MS, DNB General Surgery, Associate Professor, Department of Surgical Oncology, Medical College, Kolkata, India. Mainak Mallik* Mch, DNB Plastic Surgery, Senior Resident, Department of Plastic Surgery, Medical College, Kolkata, India. *Corresponding Author PARIPEX - INDIAN JOURNAL F RESEARCH | O April - 2020 Volume-9 | Issue-4 | | PRINT ISSN No. 2250 - 1991 | DOI : 10.36106/paripex Santanu Suba Mch Plastic Surgery, Residential Medical Officer and Clinical Tutor, Department of Plastic Surgery, Medical College, Kolkata, India. Vikram Chaturvedi DNB General Surgery, Assistant Professor, Department of Surgical Oncology, Medical College, Kolkata, India. 4 www.worldwidejournals.com