Annals of Surgical Oncology

, Volume 25, Issue 3, pp 829–836 | Cite as

Anterolateral Thigh Flap Combined with Reconstruction Plate Versus Double Free Flaps for Composite Mandibular Reconstruction: A Propensity Score-Matched Study

  • Anaeze C. OffodileII
  • Jennifer An-Jou Lin
  • Kai-Ping Chang
  • Mohamed Abdelrahman
  • Hao-Wei Kou
  • Charles Yuen Yung Loh
  • Mario A. Aycart
  • Huang-Kai Kao
Reconstructive Oncology



This study was designed to examine the comparative effectiveness of oromandibular defect reconstruction via anterolateral thigh flap and bridging plate (ALT only) versus simultaneous soft tissue and vascularized bone flap (DFF), with regards to long-term plate exposure and complications.


A propensity score-matched analysis of patients with an oncologic head and neck defect who underwent microvascular reconstruction was performed. Two surgical groups, i.e., ALT only and DFF, were created. Incidence and subsequent management strategies for postoperative plate exposure were evaluated along with complications, overall survival, and postoperative quality of life (QoL).


Sixty-two patients were 1:1 propensity matched (31 per group). The DFF group had a significantly larger soft tissue and bone defect than the single-flap group. The 5-year probability of not having a plate exposure was 45.5 and 47.4% for the double-flaps and single-flap groups, respectively (p = 0.186). The ALT-only group had a significantly higher rate of wound infections (38.7% vs. 12.9%, p = 0.02). The incidence of flap loss, reexploration, inpatient mortality, plate fracture, medical complications, and overall survival were not significantly different. Although mean score for pain was significantly worse in the ALT-only group (75.2 vs. 88.5, p < 0.001), the remainder of our QoL assessments (cosmesis, swallow, employment, and speech) were comparable.


The utilization of an ALT with plate strategy is associated with competitive rates of plate exposure and overall survival relative to DFF but higher wound infections and long-term pain. These results have considerable salience for patient-counseling regarding expectations for functional and clinical outcomes.





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Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Anaeze C. OffodileII
    • 1
  • Jennifer An-Jou Lin
    • 2
  • Kai-Ping Chang
    • 3
  • Mohamed Abdelrahman
    • 4
  • Hao-Wei Kou
    • 2
  • Charles Yuen Yung Loh
    • 2
  • Mario A. Aycart
    • 5
  • Huang-Kai Kao
    • 2
  1. 1.Department of Plastic SurgeryMD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Plastic and Reconstructive Surgery, Chang Gung Memorial HospitalChang Gung University College of MedicineTaoyuanTaiwan
  3. 3.Department of Otolaryngology-Head & Neck Surgery, Chang Gung Memorial HospitalChang Gung University College of MedicineTaoyuanTaiwan
  4. 4.Department of Surgery, Faculty of MedicineUniversity of KhartoumKhartoumSudan
  5. 5.Department of SurgeryBrigham and Women’s HospitalBostonUSA

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