Free Flap Selection and Outcomes of Soft Tissue Reconstruction Following Resection of Intra-oral Malignancy

Abstract

Introduction: Surgery to resect intra-oral malignancy is a well-established mode of primary treatment. The tissue requirement in this area is for a thin, pliable flap with minimal bulk and this has historically been provided by free tissue transfer with a radial forearm free flap (RFFF). More recently, a role for the anterolateral thigh free flap (ALTFF) has been described, although in populations with a westernized diet, body habitus may preclude use of an ALTFF due to flap thickness, relative to a radial forearm free flap. Methods: An analysis of data was performed retrospectively for 90 consecutive patients with intra-oral malignancy, requiring immediate soft tissue reconstruction by the senior author, at Addenbrooke's Hospital between July 2008 and April 2016. Cases requiring bony reconstruction were excluded. Data on patient age, sex, indication for surgery, tumor location and defect type, complications, success rates, and length of stay were recorded. Results: The majority of patients received an ALTFF (n = 56) with 38% receiving a RFFF (n = 34). Surgical resection took place in the floor of the mouth most frequently. These were closed with ALTFF and RFFF in 41 and 28 occasions, respectively. A success rate of 97% was observed in the RFFF group; 1 flap developed partial necrosis and required complete revision. In the ALTFF group, there was a 100% flap success rate. ALTFF usage resulted in a reduction in the number of intraoperative (p = 0.021) in addition a reduction in the number of days in ITU (p = 0.01) and post-operative clinic visits (p = 0.025). Conclusion: We present a series that used predominately the ALTFF to reconstruct intra-oral defects following resection of squamous cell carcinoma in a Western population. The results demonstrate that this treatment can produce at least as comparable results as to the use of a RFFF repair in this population, whilst avoiding the donor site morbidity and aesthetic compromise of a RFFF.

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

“…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.…”

Comparison of Current Free Flap Options for Intraoral Lining and Tongue Reconstruction

“…15,16 Radial forearm free flap, which was used as the first free flap for intraoral defects in 1983, 17 has been used for many years because of some advantages such as thinness, pliability, reliable anatomy, and long pedicle. 18 However, sacrificing a major artery and donor site problems 19 are the main drawbacks that resulted in choosing different types of flaps. Superficial circumflex iliac artery perforator flap is among free flap options with easy donor site management.…”

Correlation Between Body Mass Index and Anterolateral Thigh Flap Thickness: A Retrospective Study From a Single Center in China

“…With the development of microvascular anastomosis technology, grafting with a vascularized free flap has made it possible to repair and functionally restore tissue defects after maxillofacial trauma or tumor resection (15). Currently, the commonly used vascularized free flaps in the clinical practice include a radial forearm flap, deep inferior epigastric artery perforator flap, thoracodorsal artery perforator flap, deep circumflex iliac artery perforator flap, and ALT flap (16). Among them, the ALT flap has become the first choice to repair the head and neck, extremity, and truck defects in many medical centers (17,18).…”