Abstract
Anterolateral thigh flap (ALTF), since its first description, has challenged the role of the radial artery forearm free flap (RFFF) in head and neck reconstruction. The aim of our study was to objectively compare the two flaps in head and neck reconstruction. From March 2006 to January 2008, 61 head and neck reconstructions were done, 33 using RFFF and 28 using ALTF. Mean patient age was 46.93 years. There were 54 tumor and six trauma cases. Flap elevation time, pedicle length and diameter, flap failure, and re-exploration rates were not significantly different between the two flaps (p value = 0.698, 0.978, 0.832, 0.908, respectively). Significantly larger flaps were harvested from the anterolateral thigh compared to the forearm (p value = 0.000, 0.001). At the same time, the donor site complications were significantly lower in the ALTF cases (p value = 0.029). Considering the larger amount of flap available from a hidden donor site with a reliable vascular pedicle and a low frequency of donor site morbidity, we recommend that ALTF should be considered as a first choice for soft tissue defects in the head and neck region.
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Hashikawa K, Tahara S, Ishida H et al (2006) Simple reconstruction with titanium mesh and radial forearm flap after globe-sparing total maxillectomy: a 5 year follow-up study. Plast Reconstr Surg 117(3):963–967
Rashid M, Ahmad T, Sarwar SU et al (2004) Management of oromandibular cancers. J Coll Physicians Surg Pak 14(1):29–34
Swanson E, Boyd JB, Manktelow RT (1990) The radial forearm flap: reconstructive applications and donor-site defects in 35 consecutive patients. Plast Reconstr Surg 85(2):258–266
Barner HB (2008) Operative treatment of coronary atherosclerosis. Ann Thorac Surg 85(4):1473–1482
Song YG, Chen GZ, Song YL (1984) The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg 37(2):149–159
Kimura N, Satoh K (1996) Consideration of a thin flap as an entity and clinical applications of the thin anterolateral thigh flap. Plast Reconstr Surg 97(5):985–992
Yang WG, Chiang YC, Wei FC et al (2006) Thin anterolateral thigh perforator flap using a modified perforator microdissection technique and its clinical application for foot resurfacing. Plast Reconstr Surg 117(3):1004–1008
Mathes SJ, Nahai F (1997) Reconstructive surgery. Principles, anatomy and technique, vol. 2. Churchill Livingstone, New York, pp 1163–1172
Koshima I (1994) Classification of free combined or connected tissue (flap) transfers [reply to letter]. Ann Plast Surg 33:462
Koshima I, Yamamoto H, Hosoda M (1993) Free combined composite flaps using the lateral circumflex femoral system for repair of massive defects of the head and neck regions. An introduction to the chimeric flap principle. Plast Reconstr Surg 92:411
Hong JP, Shin HW, Kim JJ et al (2005) The use of anterolateral thigh perforator flaps in chronic osteomyelitis of the lower extremity. Plast Reconstr Surg 115:142
Koshima I (2000) Free Anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation [discussion]. Plast Reconstr Surg 105(7):2358–2360
Wei FC, Jain V, Celik N et al (2002) Have we found an ideal soft tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg 109(7):2219–2226
Koshima I, Fukuda H, Yamamoto H et al (1993) Free anterolateral thigh flaps for reconstruction of head and neck defects. Plast Reconstr Surg 92(3):421–428
Lueg EA (2004) The anterolateral thigh flap: radial forearm’s “Big Brother” for extensive soft tissue head and neck defects. Arch Otolaryngol Head Neck Surg 130(7):813–818
Huang CH, Chen HC, Huang YL et al (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(7):1704–1710
Farace F, Fois VE, Manconi A et al (2007) Free anterolateral thigh flap versus free forearm flap: functional results in oral reconstruction. J Plast Reconstr Aesthet Surg 60(6):583–587
Novak CB, Lipa JE, Noria S et al (2007) Comparison of anterolateral thigh and radial forearm free flap donor site morbidity. Microsurgery 27(8):651–654
Kimata Y, Uchiyama K, Ebihara S et al (1998) Anatomic variations and technical problems of anterolateral thigh flap: a report of 74 cases. Plast Reconstr Surg 102(5):1517–1523
Katre C, Shaw R, Batstone M et al (2007) Rescue of anterolateral thigh flap with absent perforators using anteromedial thigh flap. Br J Oral Maxillofac Surg 46:334–335
Shieh SJ, Chiu HY, Yu JC et al (2000) Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation. Plast Reconstr Surg 105(7):2349–2357
Koshima I (1996) Anterolateral thigh flap (discussion). In: Serafin D (ed) Atlas of microsurgical composite tissue transplantation. 1st edn. Saunders, Philadelphia, pp 430–432
Gehrking E, Remmert S, Krappen S et al (1997) Clinical comparison between radial and lateral forearm flap. Laryngorhinootologie 76(3):162–168
Kimata Y, Uchiyama K, Ebihara S et al (1997) Versatility of the free anterolateral thigh flap for reconstruction of head and neck defects. Arch Otolaryngol Head Neck Surg 123(12):1325–1331
Wei FC, Suominen S, Cheng MH et al (2002) Anterolateral thigh flap for postmastectomy breast reconstruction. Plast Reconstr Surg 110(1):82–88
González-García R, Rodríguez-Campo FJ, Naval-Gías L et al (2007) Radial forearm free flap for reconstruction of the oral cavity: clinical experience in 55 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 104(1):29–37
Celik N, Wei FC, Lin CH et al (2002) Technique and strategy in anterolateral thigh perforator flap surgery, based on an analysis of 15 complete and partial failures in 439 cases. Plast Reconstr Surg 109(7):2211–2216
Weinzweig N (2002) Anterolateral thigh flap for post mastectomy breast reconstruction [discussion]. Plast Reconstr Surg 110(1):82–88
Smith GI, O’Brien CJ, Choy ET et al (2005) Clinical outcome and technical aspects of 263 radial forearm free flaps used in reconstruction of oral cavity. Br J Oral Maxillofac Surg 43(3):199–204
Kimata Y, Uchiyama K, Sekido M et al (1999) Anterolateral thigh flap for abdominal wall reconstruction. Plast Reconstr Surg 103(4):1191–1197
Davidge K, Pusic A, Disa JJ et al (2006) Use of the anterolateral thigh flap as an alternative to the rectus flap in obese and overweight patients. Ann Plast Surg 56(5):536–539
Emerick KS, Deschler DG (2007) Incidence of donor site graft loss requiring surgical intervention with radial forearm free flap. Head Neck 29(6):573–576
de Bree R, Hartley C, Smeele LE et al (2004) Evaluation of donor site function and morbidity of the fasciocutaneous radial forearm flap. Laryngoscope 114:1973–1976
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Tamimy, M.S., Rashid, M., Islam, M.Z. et al. A comparison of free transfer of radial forearm and anterolateral thigh flaps for head and neck reconstruction. Eur J Plast Surg 32, 95–102 (2009). https://doi.org/10.1007/s00238-008-0317-0
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DOI: https://doi.org/10.1007/s00238-008-0317-0