Free Tissue Flaps for Reconstructions of Advanced Oncological Defects of the Face and Anterior Skull Base: Prospective and Randomized Study

Introduction: Advanced oncological defects of the face (AODF) with anterior skull base involvement are challenging oncological defects for reconstruction. The reconstructive microsurgery is the gold standard for reconstruction and rehabilitation of these defects, usually with vascularized fasciocutaneous and/or musculocutaneous free flaps. In the case of AODF with anterior skull base involvement, free flaps offer a better intracranial components covering, restoration of phonation, swallowing, resulting in increased quality of life and aesthetic satisfaction. Despite the different classifications of AODF and the options for reconstruction, the type of free flap that promotes the best surgical and aesthetic results remains controversial. Thus, we aimed to prospectively compare the results of AODF with anterior skull base involvement reconstructions with fasciocutaneous or musculocutaneous free flaps.

Methods: A prospective randomized study was conducted with patients allocated in a 1:1 ratio to each group at an oncology reference center. Patients without previous treatment or with recurrent advanced oncologic disease of both genders, aged over 14 years and submitted to reconstructive microsurgery for the treatment of AODF were included. The patients were divided into two groups: Group A—fasciocutaneous free flap (anterolateral thigh flap) and Group B—musculocutaneous free flap (vertical rectus abdominis or latissimus dorsi flap). The groups were prospectively compared in terms of technical aspects of free flaps, surgical complications, morbidity in the donor site, nutritional status, and postoperative aesthetic result. The results were expressed both as mean ± standard deviation and as median and percentage. Fisher’s exact test was used with a p < 0.05 considered significant. The study was approved by an international IRB.

Results: Of the 28 patients selected, 23 completed the study, of which 12 were allocated to Group A and 11 were allocated to Group B. The length of the vascular pedicle of the free flap was significantly greater in Group A (p < 0.001), while the time of flap dissection was lower in Group B (p = 0.008). The rate of major complications in the donor area of the musculocutaneous flap group was significantly higher (p = 0.037). The total flap survive was 91.30%, with one total loss in each group. There was a tendency for fasciocutaneous flaps to present better aesthetic results; however, when the statistical analysis of group comparison was carried out, there was no statistically significant difference (p = 0.109). There was no statistically significant difference in relation to the nutritional status, minor complications of free flaps and minor complications of donor site. The neurosurgical complications were similar in both groups

Conclusion: Both fasciocutaneous and musculocutaneous flaps proved to be effective for AODF reconstruction with anterior skull base involvement. The fasciocutaneous free flap proved to be an adequate option and was associated with less morbidity in the donor area, when compared to traditional musculocutaneous flaps. The fasciocutaneous free flaps and musculocutaneous free flaps have similar aesthetic results and neurosurgical complications.

Fig. 1 Preoperative MRI.

Publikationsverlauf

Artikel online veröffentlicht:
07. Februar 2025