Comparison of flap outcomes between single‐ and multiple‐perforator‐based free anterolateral thigh flap in head and neck reconstruction

Abstract

Introduction The number of perforators required for safe perfusion remains under debate. This study aimed to determine whether a single‐ or multiple‐perforator‐based anterolateral thigh flap yields better flap outcomes in head and neck reconstruction. Patients and Methods Between August 2012 and July 2016, 180 men and 4 women with a mean age of 52.8 ± 9.8 years underwent head and neck anterolateral thigh flap reconstruction for oncologic defect in 181 cases, plate exposure in two cases, and trismus release in one case. The flap was patched for inner or external lining, folded for through–through defect, or tubed for cervical esophageal reconstruction. Of 184 flaps, 136 (73.9%) were based on multiple perforators (range, 2–5 perforators), whereas 48 (26.1%) were based on a single perforator. The demographics, operative findings, and flap outcomes were compared. Results The prevalence of systemic diseases between groups was comparable. The mean flap size in the single‐perforator group was smaller (92.8 ± 36.8 vs. 140.5 ± 99.9 cm2, P < .0001). Twenty‐one flaps (11.4%) required emergency take‐back and 13 (61.9%) were successfully salvaged. Eight flaps failed, yielding a 95.7% flap survival rate. The single‐perforator group had a significantly higher rate of emergency take‐back for vascular compromise (8/48 (16.7%) vs. 8/136 (5.9%), P = .035), a decreased salvage success rate (2/8 (25.0%) vs. 11/13 (84.6%), P = .018), and a corresponding lower flap survival rate (42/48 (87.5%) vs. 134/136 (98.5%), P = .004). Conclusion Whenever possible, we recommend including multiple cutaneous perforators in anterolateral thigh flaps to yield better flap outcomes in head and neck reconstruction.

Reconstruction technique following total laryngectomy affects swallowing outcomes

“…Given current high success rates of free tissue transfer, it has become increasingly common in the reconstruction of pharyngeal defects, although many centers continue to utilize the pectoralis major flap 16‐18 . The type of reconstruction for pharyngolaryngeal defects is dependent on tumor characteristics such as T‐stage, degree of pharyngeal mucosal involvement, history of prior radiation, and patients' comorbidities 8 .…”

Creating a re-expanded prefabricated island flap constructed with an anastomosed vascular pedicle for burned ear reconstruction: a case report

“…The ALTP flap has numerous merits, including thin and large pliable skin, long and big pedicle vessels for easily bridging a vascular defect in burn wounds, and the lowest donor site morbidity ( 13 ). Even though it is safer to harvest an ALTP flap based on multiple perforators, in our case, the ALTP flap was harvested based on a single perforator because only one perforator was identified, and it did not exceed the upper limit of the available flap area as previously reported ( 14 , 15 ). However, according to our experience, an ALTP flap based on a single perforator has its own advantages of increased operability, ease of contouring, and increased pedicle reach.…”

Oropharyngeal reconstruction after transoral robotic surgery

“…Others have supported an expanded role for the ALT free flap in oropharyngeal reconstruction given its large available surface area, long pedicle, and ability to tailor variable amounts of muscle, fat, or fascia [55,56]. Multiple skin paddles may also be designed depending on the availability of multiple perforators [57 ▪ ]. In the event of excessive ALT bulk or accidental injury to ALT perforators, Ghanem [58] showed that the vastus lateralis free flap (VLFF) may be used as an alternative or rescue option.…”