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Donor site aesthetic and functional outcomes: comparison between radial forearm free flap and anterolateral thigh free flap

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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

The most commonly used free flaps are the anterolateral thigh (ALT) free flap and the radial forearm (RF) free flap, which often have overlapping indications. The aim of the present study is to compare the aesthetic and functional consequences for the donor site in patients undergoing ALT or RF flap harvesting.

Methods

A questionnaire was administered to each patient to assess the functionality and aesthetics of the donor site. We used three different scales validated in the literature: the Patient and Observer Scar Assessment Scale (POSAS), the Manchester Scar Scale (MSS), and the donor site functionality questionnaire developed by Liu and colleagues. A total of 54 patients underwent ALT or RF free flap harvesting at the University Hospital of Verona in the period between February 2016 and September 2019. Of these, 14 had died at the time of the study. In addition, a complete follow-up was not available in 9 patients and they were therefore excluded from the study. Therefore, a total of 31 patients, 15 of whom underwent ALT flap harvesting (48%) and 16 RF flap harvesting (52%), were analyzed in the present study. Out of the 31 patients, 11 (36%) were female and 20 (64%) were male. The mean age at the time of surgery was 61 years (± 16 (SD), and ranging from 23 to 87 years). The flap size was on average 142.6 cm2 (90–198) in the ALT group and 36.5 cm2 (20–63) in the RFFF group.

Results

Overall observer total score of the POSAS was 12 (8–15) for the ALT flap and 9.5 for the RF flap. For the patients’ opinion of the POSAS scale, the overall patient total score was 16 for the ALT flap and 9 for the RF flap. There was no difference in overall observer total score nor in patients opinion score between ALT and RF (12 (8–15) compared to 9.5 (8–12.25) and 16 (9.5–20) compared to 9 (7.75–15) (p = 0.28 and p = 0.13, respectively). For the MSS, the RF flap had a significantly better result with the VAS (visual analog scale) score (p = 0.04) compared with the ALT flap. In total, 94% of patients undergoing RF flap harvesting were satisfied with the appearance of the forearm against 73% of patients with the ALT flap.

Conclusions

In this case series, the RF donor site achieved slightly better aesthetic and functional outcomes than the ALT donor site. Our results are discordant with the majority of published international studies, and are probably related to surgical management of the RF donor site using a locally harvested full-thickness skin graft (FTSG).

Level of evidence: Level III, therapeutic/prognostic study.

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References

  1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA Cancer J Clin 65(2):87–108

    Article  Google Scholar 

  2. De Ridder M, de Veij Mestdagh PD, Elbers JBW et al (2020) Disease course after the first recurrence of head and neck squamous cell carcinoma following (chemo)radiation. Eur Arch Otorhinolaryngol 277(1):261–268

    Article  Google Scholar 

  3. Bossi P, Alfieri S, Strojan P et al (2019) Prognostic and predictive factors in recurrent and/or metastatic head and neck squamous cell carcinoma: a review of the literature. Crit Rev Oncol Hematol 137:84–91

    Article  Google Scholar 

  4. Hamoir M, Schmitz S, Suarez C et al (2018) The current role of salvage surgery in recurrent head and neck squamous cell carcinoma. Cancers (Basel) 10(8):267

    Article  Google Scholar 

  5. Vincent A, Kohlert S, Lee TS, Inman J, Ducic Y (2019) Free-flap reconstruction of the tongue. Semin Plast Surg 33(1):38–45

    Article  Google Scholar 

  6. Abouyared M, Katz AP, Ein L et al (2019) Controversies in free tissue transfer for head and neck cancer: a review of the literature. Head Neck 41(9):3457–3463

    Article  Google Scholar 

  7. Cai YC, Li C, Zeng DF et al (2019) Comparative analysis of radial forearm free flap and anterolateral thigh flap in tongue reconstruction after radical resection of tongue cancer. ORL J Otorhinolaryngol Relat Spec 18:1–13

    Google Scholar 

  8. Novak CB, Lipa JE, Noria S, Allison K, Neligan PC, Gilbert RW (2007) Comparison of anterolateral thigh and radial forearm free flap donor site morbidity. Microsurgery 27:651–654

    Article  Google Scholar 

  9. Huang CH, Chen HC, Huang YL, Mardini S, Feng GM (2004) Comparison of the radial forearm flap and the thinned anterolateral thigh cutaneous flap for reconstruction of tongue defects: an evaluation of donor-site morbidity. Plast Reconstr Surg 114:1704–1710

    Article  Google Scholar 

  10. Liu W-W, Li H, Guo Z-M et al (2011) Reconstruction of soft-tissue defects of the head and neck: radial forearm flap or anterolateral thigh flap? Eur Arch Otorhinolaryngol 268(12):1809–1812

    Article  Google Scholar 

  11. Fearmonti R, Bond J, Erdmann D, Levinson H (2010) A review of scar scales and scar measuring devices. Eplasty 10:354–363

    Google Scholar 

  12. Draaijers JL, Tempelman FR, Botman YAM et al (2004) The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg 113:1960–1965

    Article  Google Scholar 

  13. Vercelli S, Ferriero G, Sartorio F, Stissi V, Franchignoni F (2009) How to assess postsurgical scars: a review of outcome measures. Disabil Rehabil 25(31):2055–2063

    Article  Google Scholar 

  14. Van de Kar AL, Corion LUM, Smeulders MJC, Draaijers LJ, Van der Horst CM, Van Zuijlen PP (2005) Reliable and feasible evaluation of linear scars by the patient and observer scar assessment scale. Plast Reconstr Surg 116:514–522

    Article  Google Scholar 

  15. Kimata Y, Uchiyama K, Ebihara S et al (2000) Anterolateral thigh flap donor-site complications and morbidity. Plast Reconstr Surg 106:584–589

    Article  CAS  Google Scholar 

  16. Pachón Suárez JE, Sadigh PL, Shih HS et al (2014) Achieving direct closure of the anterolateral thigh flap donor site–an algorithmic approach. Plast Reconstr Surg Glob Open 2:e232

    Article  Google Scholar 

  17. Fischer S, Diehm Y, Hirche C et al (2017) Comparison of sub- versus suprafascially raised anterolateral thigh free flaps with regard to donor-site morbidity, function and aesthetics. Microsurgery 38(5):444–449

    Article  Google Scholar 

  18. Collins J, Ayeni O, Thoma A (2012) A systematic review of anterolateral thigh flap donor site morbidity. Can J Plast Surg 20(1):17–23

    Article  Google Scholar 

  19. Molteni G, Ghirelli M, Molinari G, Presutti L (2019) Microvascular reconstruction two years after subtotal glossectomy: is it worth it? J Stomatol Oral Maxillofac Surg 120(1):49–54. https://doi.org/10.1016/j.jormas.2018.08.006

    Article  CAS  PubMed  Google Scholar 

  20. Lipa JE, Novak CB, Binhammer PA (2005) Patient-reported donor-site morbidity following anterolateral thigh free flaps. J Reconstr Microsurg 21:365–370

    Article  Google Scholar 

  21. Hanasono MM, Skoracki RJ, Yu P (2010) A prospective study of donor-site morbidity after anterolateral thigh fasciocutaneous and myocutaneous free flap harvest in 220 patients. Plast Reconstr Surg 125:209–214

    Article  CAS  Google Scholar 

  22. Yang G, Chen B, Gao W et al (1981) Forearm free skin flap transplantation. Natl Med J China 61:139–141

    Google Scholar 

  23. Timmons MJ, Misotten FE, Poole MD, Davies DM (1986) Complications of radial forearm flap donor sites. Br J Plast Surg 39:176–178

    Article  CAS  Google Scholar 

  24. Toschka H, Feifel H, Erli H-J, Minkenberg R, Paar O, Riediger D (2001) Aesthetic and functional results of harvesting radial forearm flap, especially with regard to hand function. Int Oral Maxillofac Surg 30(1):42–48

    Article  CAS  Google Scholar 

  25. Rhemrev R, Rakhorst HA, Zuidam JM, Mureau MA, Hovius SE, Hofer SO (2007) Long-term functional outcome and satisfaction after radial forearm free flap reconstructions of intraoral malignancy resections. J Plast Reconstr Aesthet Surg 60(6):588–592

    Article  CAS  Google Scholar 

  26. Kim SM, Park JM, Yang HJ, Myoung H, Lee SK, Lee JH (2016) Aesthetic closure of the donor site of a radial forearm free flap with two local curved skin grafts. J Plast Surg Hand Surg 50(3):184–186

    Article  Google Scholar 

  27. Wester JL, Pittman AL, Lindau RH, Wax MK (2014) AlloDerm with split-thickness skin graft for coverage of the forearm free flap donor site. Otolaryngol Head Neck Surg 150(1):47–52

    Article  Google Scholar 

  28. Moreno-Sanchez M, Gonzalez-Garcia R, Ruiz-Laza L, Solo Manzano, de Zaldivar D, Moreno-Garcia C, Monje F (2016) Closure of the radial forearm free flap donor site using the combined local triangular full-thickness skin graft. J Oral Maxillofac Surg 74(1):204–211

    Article  Google Scholar 

  29. Sleeman D, Carton AT, Stassen LF (1994) Closure of radial forearm free flap defect using full-thickness skin from the anterior abdominal wall. Br J Oral Maxillofac Surg 32(1):54–55

    Article  CAS  Google Scholar 

  30. Byun SH, Ahn KM, Kim SM, Lee JH (2016) Functional and cosmetic outcome after closure of radial forearm free flap donor defect with porcine collagen membrane. J Craniomaxillofac Surg 44(5):527–532

    Article  Google Scholar 

  31. Lee MC, Jang YJ, Yun IS et al (2017) Comparative skin evaluation after split-thickness skin grafts using 2 different acellular dermal matrices to cover composite forearm defects. J Hand Surg Am 42(4):297.e1-297.e10

    Article  Google Scholar 

  32. Pabs AM, Werkmeister R, Steegmann J, Hölzle F, Bartella A (2018) Is there an ideal way to close the donor site of radial forearm free flaps? Br J Oral Maxillofac Surg 56(6):444–452

    Article  Google Scholar 

  33. Pirlich M, Horn IS, Mozet C, Dietz A, Fischer M (2018) Functional and cosmetic donor site morbidity of the radial forearm-free flap: comparison of two different coverage techniques. Eur Arch Otorhinolaryngol 275(5):1219–1225

    Article  Google Scholar 

  34. Zuidam JM, Coert JH, Hofer SO (2005) Closure of the donor site of the free radial forearm flap: a comparison of full-thickness graft and split-thickness skin graft. Ann Plast Surg 55(6):612–616

    Article  CAS  Google Scholar 

  35. Ho T, Couch M, Carson K, Schimber A, Manley K, Byrne PJ (2006) Radial forearm free flap donor site outcomes comparison by closure methods. Otolaryngol Head Neck Surg 134(2):309–315

    Article  Google Scholar 

  36. Van der Lei B, Spronk CA, Visscher JG (1999) Closure of radial forearm free flap donor site with local full-thickness skin graft. Br J Oral Maxillofac Surg 37(2):119–122

    Article  Google Scholar 

  37. Riecke B, Assaf AT, Heiland M et al (2015) Local full-thickness skin graft of the donor arm–a novel technique for the reduction of donor site morbidity in radial forearm free flap. Int J Oral Maxillofac Surg 44(8):937–941

    Article  CAS  Google Scholar 

  38. Giordano L, Bondi S, Ferrario F, Fabiano B, Bussi M (2012) Radial forearm free flap surgery: a modified skin-closure technique improving donor-site aesthetic appearance. Acta Otorhinolaryngol Ital 32(3):158–163

    CAS  PubMed  PubMed Central  Google Scholar 

  39. Loreti A, Di Lella G, Vetrano S, Tedaldi M, Dell’Osso A, Poladas G (2008) Thinned anterolateral thigh cutaneous flap and radial fasciocutaneous forearm flap for reconstruction of oral defects: comparison of donor site morbidity. J Oral Maxillofac Surg 66:1093–1098

    Article  Google Scholar 

  40. Oranges CM, Ling B, Tremp M, Wettstein R, Kalbermatten DF, Schaefer DJ (2018) Comparison of anterolateral thigh and radial forearm free flaps in head and neck reconstruction. Vivo 32(4):893–897

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology-Head and Neck Surgery, Verona University Hospital, Verona, Italy

    Gabriele Molteni, Luca Gazzini, Cecilia Albi, Riccardo Nocini & Daniele Marchioni

  2. Department of Maxillofacial Surgery, Verona University Hospital, Verona, Italy

    Andrea Fior

Authors
  1. Gabriele Molteni
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  2. Luca Gazzini
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  3. Cecilia Albi
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  4. Andrea Fior
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  5. Riccardo Nocini
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  6. Daniele Marchioni
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by all the authors. The first draft of the manuscript was written by all authors. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Luca Gazzini.

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Ethical approval

All of the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethical approval by the ethics committee for clinical trials of the provinces of Verona and Rovigo was obtained.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

Gabriele Molteni, Luca Gazzini, Cecilia Albi, Andrea Fior, Riccardo Nocini, and Daniele Marchioni declare no competing interests.

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Molteni, G., Gazzini, L., Albi, C. et al. Donor site aesthetic and functional outcomes: comparison between radial forearm free flap and anterolateral thigh free flap. Eur J Plast Surg 45, 409–414 (2022). https://doi.org/10.1007/s00238-021-01889-z

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  • DOI: https://doi.org/10.1007/s00238-021-01889-z

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