Objective Selection Criteria between ALT and Radial Forearm Flap in Oral Soft Tissues Reconstruction

Abstract

Different locoregional and free flaps were described for oral soft tissues reconstruction after oncological resections; however, free flaps remain the first choice. Among free flaps, the radial forearm flap (RFF) and the anterolateral thigh perforator flap (ALT) are preferred the most. The lack of standardization of the flap choice leaves the selection to the surgeon's experience. The purpose of our observational study is to provide an algorithm to support the flap choice for the reconstruction of oral soft tissues. Sixty patients with squamous cell carcinoma of oral soft tissues were enrolled in our study. All the patients underwent preoperative magnetic resonance imaging (MRI) to measure the three-dimensional size of the tumor. During the follow-up, the patients were evaluated by using the University of Washington-Quality of Life Questionnaire. The questionnaire score was better for small tumors and worse for large tumors in both functional and relational fields. We observed that most of the overlapping results were obtained for small defects and the choice of RFF, as well as for large defects and the use of ALT. We observed that in the preoperative time, it is possible to select which flap between radial forearm and ALT is more appropriate for oral soft tissues defects reconstruction, according to the size of the tumor evaluated by MRI. We propose a decisional algorithm that suggests the type of flap to use between ALT and RFF.

Keywords

oral soft tissue reconstruction - radial forearm flap - anterolateral thigh flap - flap selection

• References

• 1 Wong CH, Wei FC. Microsurgical free flap in head and neck reconstruction. Head Neck 2010; 32 (09) 1236-1245
• 2 Nakatsuka T, Harii K, Asato H. et al. Analytic review of 2372 free flap transfers for head and neck reconstruction following cancer resection. J Reconstr Microsurg 2003; 19 (06) 363-368 discussion 369
• 3 McCrory AL, Magnuson JS. Free tissue transfer versus pedicled flap in head and neck reconstruction. Laryngoscope 2002; 112 (12) 2161-2165
• 4 Smith RB, Sniezek JC, Weed DT, Wax MK. Microvascular Surgery Subcommittee of American Academy of Otolaryngology—Head and Neck Surgery. Utilization of free tissue transfer in head and neck surgery. Otolaryngol Head Neck Surg 2007; 137 (02) 182-191
• 5 Li W, Yang Y, Xu Z. et al. Assessment of quality of life of patients with oral cavity cancer who have had defects reconstructed with free anterolateral thigh perforator flaps. Br J Oral Maxillofac Surg 2013; 51 (06) 497-501
• 6 de Vicente JC, de Villalaín L, Torre A, Peña I. Microvascular free tissue transfer for tongue reconstruction after hemiglossectomy: a functional assessment of radial forearm versus anterolateral thigh flap. J Oral Maxillofac Surg 2008; 66 (11) 2270-2275
• 7 Ariyan S, Ross DA, Sasaki CT. Reconstruction of the head and neck. Surg Oncol Clin N Am 1997; 6 (01) 1-43
• 8 Blackwell KE, Buchbinder D, Biller HF, Urken ML. Reconstruction of massive defects in the head and neck: the role of simultaneous distant and regional flaps. Head Neck 1997; 19 (07) 620-628
• 9 Disa JJ, Pusic AL, Hidalgo DH, Cordeiro PG. Simplifying microvascular head and neck reconstruction: a rational approach to donor site selection. Ann Plast Surg 2001; 47 (04) 385-389
• 10 Thiele OC, Seeberger R, Engel M, Freier K, Hoffmann J. Development of the clinical use of distant flaps for head and neck reconstruction. J Craniomaxillofac Surg 2014; 42 (01) 79-83
• 11 Hassan SJ, Weymuller Jr EA. Assessment of quality of life in head and neck cancer patients. Head Neck 1993; 15 (06) 485-496
• 12 Hay A, Nixon IJ. Recent advances in the understanding and management of oropharyngeal cancer. F1000 Res 2018; 7: 7
• 13 Mehta S, Sarkar S, Kavarana N, Bhathena H, Mehta A. Complications of the pectoralis major myocutaneous flap in the oral cavity: a prospective evaluation of 220 cases. Plast Reconstr Surg 1996; 98 (01) 31-37
• 14 Ragbir M, Brown JS, Mehanna H. Reconstructive considerations in head and neck surgical oncology: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol 2016; 130 (S2) S191-S197
• 15 Vos JD, Burkey BB. Functional outcomes after free flap reconstruction of the upper aerodigestive tract. Curr Opin Otolaryngol Head Neck Surg 2004; 12 (04) 305-310
• 16 Harashina T, Fujino T, Aoyagi F. Reconstruction of the oral cavity with a free flap. Plast Reconstr Surg 1976; 58 (04) 412-414
• 17 Kim EK, Evangelista M, Evans GR. Use of free tissue transfers in head and neck reconstruction. J Craniofac Surg 2008; 19 (06) 1577-1582
• 18 Yang GF, Chen PJ, Gao YZ. et al. Forearm free skin flap transplantation: a report of 56 cases. 1981. Br J Plast Surg 1997; 50 (03) 162-165
• 19 Chim H, Salgado CJ, Seselgyte R, Wei FC, Mardini S. Principles of head and neck reconstruction: an algorithm to guide flap selection. Semin Plast Surg 2010; 24 (02) 148-154
• 20 Soutar DS, McGregor IA. The radial forearm flap in intraoral reconstruction: the experience of 60 consecutive cases. Plast Reconstr Surg 1986; 78 (01) 1-8
• 21 Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg 1984; 37 (02) 149-159
• 22 Chana JS, Wei FC. A review of the advantages of the anterolateral thigh flap in head and neck reconstruction. Br J Plast Surg 2004; 57 (07) 603-609
• 23 Stark B, Nathanson A, Hedén P, Jernbeck J. Results after resection of intraoral cancer and reconstruction with the free radial forearm flap. ORL J Otorhinolaryngol Relat Spec 1998; 60 (04) 212-217
• 24 Yadav P. Recent advances in head and neck cancer reconstruction. Indian J Plast Surg 2014; 47 (02) 185-190
• 25 Neligan PC. Head and neck reconstruction. Plast Reconstr Surg 2013; 131 (02) 260e-269e
• 26 Huang CH, Chen HC, Huang YL, Mardini S, Feng GM. 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 2004; 114 (07) 1704-1710
• 27 Gurtner GC, Evans GR. Advances in head and neck reconstruction. Plast Reconstr Surg 2000; 106 (03) 672-682 quiz 683