Comparison of the outcomes between free anteromedial thigh flap and anterolateral thigh flap in head and neck cancer reconstruction: Analysis of propensity‐score‐matched patient cohorts

Abstract

Background The anterolateral thigh (ALT) flap is a workhorse flap in head and neck cancer reconstruction. The anteromedial thigh (AMT) flap was developed as a rescue or alternative flap whenever the ALT flap is not available; however, the harvest of AMT flap seems to be more challenging in the sense that perforators have multiple variations. This study was designed to compare the outcome of the AMT and ALT flaps in head and neck cancer reconstruction. Methods A total of 1,547 ALT and 57 AMT flaps were used for head and neck cancer reconstruction between March 1, 2008 and February 28, 2017. Differences in patient and operative characteristics were compared between the patients undergoing AMT and ALT flap reconstruction. The primary outcome of the free flap was its survival or failure, while the second outcome was the associated complications. Results Compared to those who had ALT flap reconstruction, the patients who underwent AMT flap reconstruction had a higher rate of conditions that required reconstruction after previous cancer ablation and recurrence but a lower rate of primary cancer and deeply located cancer. Analysis of the 40 well‐balanced pairs of propensity‐score‐matched patient cohorts revealed that the AMT flaps were associated with a significantly higher failure rate than the ALT flaps (15.0 vs. 0.0%, respectively; p = .026). Conclusion This study revealed that AMT flaps were associated with a significantly higher failure rate than ALT flaps in head and neck cancer reconstruction in the cohort of total patients and the propensity‐score‐matched cohorts.

The Impact of Marijuana Use on Postoperative Outcomes in Abdominal-based Free Flap Breast Reconstruction

“…showing no increased risk of complications associated with a diagnosis of cannabis use. 10 There were no major anesthesia-related adverse events observed in either patient group, such as myocardial infarction, airway compromise, or major neurological deterioration. This is likely attributed to the overall rarity of these events and the underpowered nature of our small study.…”

“…propensity score matching analysis focusing on cannabis use in flap reconstruction patients demonstrated no significant difference in flap revision or medical and surgical complications. 10 Given marijuana's impact on the cardiovascular system, endothelial dysfunction, and pro-coagulant state, 11,12 exploring whether this effect extends to microsurgery is a pertinent consideration. Nevertheless, there is currently no outcome study specifically addressing marijuana use in patients undergoing microsurgical reconstruction in the literature.…”

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

“…For many years, the ALTP flap has been the preferred choice for neck and head defect reconstruction ( 12 ). 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 ).…”

Role of microsurgical free flap reconstruction in managing complex wound: a retrospective cross-sectional study

“…Venous thrombosis, vessel kinking, and spasms have been reported as common causes of total free-flap failure in the early phase following microvascular anastomosis [ 30 ]. In our study, most osteocutaneous fibula flaps were utilized for post-cancer resection, and prior chemotherapy, radiotherapy, and nutritional status may contribute to more failure [ 31 ]. Another possibility for total flap loss is trauma during the fibula graft preparation, segmentation, and shaping [ 32 ].…”