Comparison of Anterolateral Thigh and Radial Forearm Free Flaps in Head and Neck Reconstruction

Oranges, Carlo M.; Ling, Barbara; Tremp, Mathias; Wettstein, Reto; Kalbermatten, Daniel F.; Schaefer, Dirk J.

doi:10.21873/invivo.11325

Cited by 24 publications

(22 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…At this location, the diameter of the perforator is small and can be easily damaged by traction kinking Nevertheless, ALTFF has the advantage of harvesting a greater amount of tissue than RFFF, as well as the direct primary closure is possible if the width of donor site is less than 8 cm. Several studies favoring the benefits of ALTFF reported no significant difference in flap survival rates between RFFF and ALTFF [15][16][17][18]; however, in this study, the success rate of RFFF (98.9%) was significantly higher than of ALTFF (94.5%) (p< 0.01). Mandibular reconstruction was performed using fibular OCFF (33 cases) or DCIA osteocutaneous flaps (2 cases); two fibular OCFF failed.…”

Section: Discussioncontrasting

confidence: 83%

Head and neck reconstruction using free flaps: a 30-year medical record review

Suh

Chung

Chang

2021

Arch Craniofac Surg

View full text Add to dashboard Cite

Background The free flap surgical method is useful for the reconstruction of head and neck defects. This study retrospectively analyzed the results of head and neck reconstructions using various types of free flaps over the past 30 years. Methods Between 1989 and 2018, a total of 866 free flap procedures were performed on 859 patients with head and neck defects, including 7 double free flaps. The causes of vascular crisis and salvage rate were analyzed, and the total flap survival rate calculated among these patients. Additionally, the survival and complication rates for each flap type were compared. Results The 866 cases included 557 radial forearm flaps, 200 anterolateral thigh flaps, 39 fibular osteocutaneous flaps, and 70 of various other flaps. The incidence of the vascular crisis was 5.1%; its most common cause was venous thrombosis (52.3%). Salvage surgery was successful in 52.3% of patients, and the total flap survival rate was 97.6%. The success rate of the radial forearm flap was higher than of the anterolateral flap ( p <0.01), and the primary sites of malignancy were the tongue, tonsils, and hypopharynx, respectively. Conclusion The free flap technique is the most reliable method for head and neck reconstruction; however, the radial forearm free flap showed the highest success rate (98.9%). In patients with malignancy, flap failure was more common in the anterolateral thigh (5.5%) and fibular (5.1%) flaps.

show abstract

Section: Discussioncontrasting

confidence: 83%

Head and neck reconstruction using free flaps: a 30-year medical record review

Suh

Chung

Chang

2021

Arch Craniofac Surg

View full text Add to dashboard Cite

show abstract

“…The incidence of the complications of the lateral skull base tumour extensive resection followed by reconstruction specifically with ALT flap reported in the recent literature presents inconsistent opinions. The published series are based on small numbers of patients from 2 to 18 [14–16, 19, 23, 25–28]. Lin et al used ALT flap in seven patients for reconstruction of lateral skull defect.…”

Section: Discussionmentioning

confidence: 99%

“…Complications occurred at the recipient site in six patients: infections in two, haematoma in two and dehiscence in two cases. They reported the donor-site complications in four patients, mainly due to dehiscence [16].…”

Section: Discussionmentioning

confidence: 99%

“…This can be attributed to the poor quality of vessels, deprived compensation of blood loss and capacity to withstand lengthy surgical procedures. The age of over 60 years is recognised to be an important risk factor in the management of the temporal bone defects after oncologic resection [16]. In the described series of 17 patients, 12 were over 70 years of age.…”

Section: Discussionmentioning

confidence: 99%

“…An anterolateral thigh flap (ALT) is often used in the head and neck region reconstruction, but in the repair of the lateral skull base defects, the experience is limited. Particularly, the evaluation of the recipient and the donor-site complications are unequivocal in the recent literature [14–16].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Anterolateral thigh free flap in reconstruction of lateral skull base defects after oncological resection

Trojanowski

Szymański

Trojanowska

et al. 2019

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

PurposeEvaluation of the utility of the free anterolateral thigh flap reconstruction of the defects resulting from radical temporal bone resection in the management of lateral skull base malignancies in a single institution.MethodsAn analysis of 17 en bloc subtotal petrosectomies for removal of malignant tumours was performed. There were 12 squamous cell carcinomas, 4 basal cell carcinomas and 1 adenoid cystic carcinoma. The tumours were staged with the University of Pittsburgh TNM system. In all patients, the lateral temporal bone with the preservation of the petrous apex and carotid artery was performed. All patients had parotid gland resection. The post-resection defect was reconstructed with an ALT free flap.ResultsTumour radical resection and defect reconstruction with an ALT flap was achieved in all patients without intraoperative complications. The transplants were harvested as fasciocutaneous flaps, 11 perfused by musculocutaneous and 6 by septocutaneous perforators. The ALT flaps had a mean pedicle length of 8 cm (6–12 cm), and the flap size ranged between 6 × 15 cm and 15 × 30 cm. The flaps were supplied by nine facial, five occipital and three maxillary arteries. Recipient-site veins included eight internal jugular, seven facial, one retromandibular and one external jugular vein. All arterial pedicles were anastomosed in an end-to-end manner. The veins were anastomosed with interrupted sutures and in 11 cases with Synovis-Coupler® devices. All the flap transfers were performed successfully. Three patients experienced postoperative complications.ConclusionsThe ALT flap proved to be effective for covering large temporal skull base defects resulting from the radical removal of temporal bone malignancies. The functional and cosmetic results were acceptable with a low complication rate.

show abstract

Evaluation of hyperspectral imaging to quantify perfusion changes during the modified Allen test

Linek¹,

Felicio‐Briegel

Freymüller³

et al. 2021

Lasers Surg Med

View full text Add to dashboard Cite

Objectives To evaluate the capability of hyperspectral imaging (HSI), a contact‐less and noninvasive technology, to monitor perfusion changes of the hand during a modified Allen test (MAT) and cuff occlusion test. Furthermore, the study aimed at obtaining objective perfusion parameters of the hand. Methods HSI of the hand was performed on 20 healthy volunteers with a commercially available HSI system during a MAT and a cuff occlusion test. Besides gathering red‐green‐blue (RGB) images, the perfusion parameters tissue hemoglobin index (THI), (superficial tissue) hemoglobin oxygenation (StO2), near‐infrared perfusion (NIR), and tissue water index (TWI) were calculated for four different regions of interest on the hand. For the MAT, occlusion (OI; the ratio between the condition during occlusion and before occlusion) and reperfusion (RI; the ratio between the non‐occlusion state and the prior occlusion state) indices were calculated for each perfusion parameter. All data were correlated to the clinical findings. Results False‐color images showed visible differences between the various perfusion conditions during the MAT and cuff occlusion test. THI, StO2, and NIR behaved as expected from physiology, while TWI did not in the context of this study. During rest, mean THI, StO2, and NIR of the hand were 34 ± 2, 72 ± 9, and 61 ± 6, respectively. The RI for THI showed a roundabout threefold increase after reperfusion of both radial and ulnar artery and was thus, distinctly pronounced when compared with StO2 and NIR (~1.25). The OI was lowest for THI when compared with StO2 and NIR. Conclusions HSI with its parameters THI, StO2, and NIR proved to be suitable to evaluate perfusion of the hand. By this, it could complement visual inspection during the MAT for evaluating the functionality of the superficial palmary arch before radial or ulnar artery harvest. The presented RI might deliver useful comparative values to detect pathological perfusion disorders at an early stage. As microcirculation monitoring is crucial for many medical issues, HSI shows potential to be used, besides further applications, in the monitoring of (free) flaps and transplants and microcirculation monitoring of critically ill patients.

show abstract

Comparison of Anterolateral Thigh and Radial Forearm Free Flaps in Head and Neck Reconstruction

Abstract: In our experience, ALT and RFF demonstrated analogous practicability and reliability for the reconstruction of head and neck soft-tissue defects, with similar local and systemic complications and donor-site morbidity rates.

Cited by 24 publications

References 37 publications

Head and neck reconstruction using free flaps: a 30-year medical record review

Head and neck reconstruction using free flaps: a 30-year medical record review

Anterolateral thigh free flap in reconstruction of lateral skull base defects after oncological resection

Evaluation of hyperspectral imaging to quantify perfusion changes during the modified Allen test

Contact Info

Product

Resources

About