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Comparative Study
. 2008 Feb;28(1):7-12.

Anterolateral thigh cutaneous flap vs. radial forearm free-flap in oral and oropharyngeal reconstruction: an analysis of 48 flaps

A Camaioni  1 , A Loreti, V Damiani, M Bellioni, F M Passali, C Viti
Affiliations
Comparative Study

Anterolateral thigh cutaneous flap vs. radial forearm free-flap in oral and oropharyngeal reconstruction: an analysis of 48 flaps

A Camaioni et al. Acta Otorhinolaryngol Ital. 2008 Feb.

Abstract
in English, Italian

Microvascular free-flaps have been in clinical use for nearly 3 decades becoming the gold standard in oral and oropharyngeal reconstruction. In this study, a comparison has been made between the radial forearm fasciocutaneous flap with the thinned anterolateral thigh cutaneous flap (tALT), showing the advantage of the anterolateral thigh cutaneous flap in oral and oropharyngeal reconstruction. Between January 2003 and January 2007, 48 reconstructions were performed in patients submitted to surgery for oral and oropharyngeal carcinoma using, in 17 cases, a radial forearm fasciocutaneous flap and, in 31, an anterolateral thigh cutaneous flap. In patients treated with the radial forearm fasciocutaneous flap, results showed 94.1% flap survival; in cases treated with the anterolateral thigh cutaneous flap, 93.5% flap survival (p < 0.9). Functional results, at receiving site, were comparable in both groups. Functional results, at donor site, were less successful in the radial forearm fasciocutaneous flap group, with permanent forearm movement impairment in 35.3% of cases; in the anterolateral thigh cutaneous flap group, only transitory gait impairment occurred in 12.9% of patients. In conclusion, in our experience, the thinned anterolateral thigh cutaneous flap is comparable to radial forearm fasciocutaneous flap in terms of functional results at receiving site, but, having no limitation in availability of donor tissue, it allows a more extended resection of the tumour. Moreover, the donor site can be closed primarily with only an inconspicuous curvilinear scar left over the thigh and with significantly reduced functional impairment.

I lembi liberi microvascolari sono nell’uso clinico da circa tre decadi e sono progressivamente diventati il gold standard per la ricostruzione della regione orale ed orofaringea. Nel presente studio, abbiamo confrontato il lembo libero radiale (RFFF) con il lembo anterolaterale di coscia assottigliato (tALT), mostrando i vantaggi del tALT nella ricostruzione orale ed orofaringea. Tra gennaio 2003 e gennaio 2007, abbiamo eseguito 48 ricostruzioni microvascolari in pazienti operati per carcinoma orale od orofaringeo, usando un RFFF in 17 casi ed un tALT in 31. Nei pazienti trattati con RFFF o tALT abbiamo ottenuto rispettivamente un 94,1% ed un 93,5% di sopravvivenza (p < 0,9). I risultati funzionali a livello del sito ricevente sono stati sovrapponibili nei 2 gruppi. I risultati funzionali a livello del sito donatore sono stati, invece, decisamente peggiori nel gruppo trattato con RFFF, con un’alterazione permanente della motilità del braccio in 35,3% dei casi; nel gruppo trattato con tALT abbiamo notato una transitoria alterazione della marcia nel 12,9% dei pazienti. In conclusione, nella nostra esperienza, il tALT è paragonabile al RFFF in termini di risultati funzionali a livello del sito ricevente, ma, non avendo limitazioni di tessuto donatore, consente una resezione più ampia della neoplasia. Inoltre, il sito donatore può essere facilmente chiuso di prima intenzione, con soltanto una residuale cicatrice curvilinea sulla coscia e con alterazioni funzionali significativamente ridotte.

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Figures

Fig. 1
Fig. 1
Elevated radial forearm fasciocutaneous free flap (RFFF).
Fig. 2
Fig. 2
Elevated thinned anterolateral thigh cutaneous free flap (tALT flap).
Fig. 3a
Fig. 3a
a. Tongue carcinoma: pre-operative appearance
Fig. 3b
Fig. 3b
b. Tongue carcinoma: reconstruction with RFFF.
Fig. 4a
Fig. 4a
a.Tongue carcinoma: pre-operative aspect.
Fig. 4b
Fig. 4b
b. Tongue carcinoma: reconstruction with tALT.
Fig. 5a
Fig. 5a
Scar retraction and pigmentation.
Fig. 5b
Fig. 5b
Exposure of tendons.
Fig. 5c
Fig. 5c
Partial necrosis of flap.
Fig. 5d
Fig. 5d
Diffuse necrosis of flap.
Fig. 6
Fig. 6
Subjective outcome assessment of donor site
Fig. 7
Fig. 7
7a and 7b. tALT: donor site healing in two cases.
Fig. 7
Fig. 7
7a and 7b. tALT: donor site healing in two cases.
See this image and copyright information in PMC

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