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

  • Reconstructive Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Objective

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.

Methods

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).

Results

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.

Conclusions

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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Author notes

  1. Anaeze C. Offodile II and Jennifer An-Jou Lin have equally contributed to this work.

Authors and Affiliations

  1. Department of Plastic Surgery, MD Anderson Cancer Center, Houston, TX, USA

    Anaeze C. Offodile II MD, MPH

  2. Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan

    Jennifer An-Jou Lin MD, Hao-Wei Kou MD, Charles Yuen Yung Loh MBBS, MSc, MRCS & Huang-Kai Kao MD, FACS

  3. Department of Otolaryngology-Head & Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan

    Kai-Ping Chang MD, PhD

  4. Department of Surgery, Faculty of Medicine, University of Khartoum, Khartoum, Sudan

    Mohamed Abdelrahman MD

  5. Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Mario A. Aycart MD

Authors
  1. Anaeze C. Offodile II MD, MPH
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  2. Jennifer An-Jou Lin MD
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  3. Kai-Ping Chang MD, PhD
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  4. Mohamed Abdelrahman MD
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  5. Hao-Wei Kou MD
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  6. Charles Yuen Yung Loh MBBS, MSc, MRCS
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  8. Huang-Kai Kao MD, FACS
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Correspondence to Huang-Kai Kao MD, FACS.

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Offodile, A.C., Lin, J.AJ., Chang, KP. et al. Anterolateral Thigh Flap Combined with Reconstruction Plate Versus Double Free Flaps for Composite Mandibular Reconstruction: A Propensity Score-Matched Study. Ann Surg Oncol 25, 829–836 (2018). https://doi.org/10.1245/s10434-017-6309-1

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  • DOI: https://doi.org/10.1245/s10434-017-6309-1

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