Evaluation of early surgical and functional outcomes of anterolateral thigh free flap and radial forearm free flap for reconstruction of soft tissue defects of oral cavity

Nabina Rahman; M. Mostafizur Rahman; Enora Nilomi; Mostakim Maria Alievna; M. Ariful Islam Sumon; Rayhana Awwal

doi:10.18203/2349-2902.isj20253450

Authors

Nabina Rahman Department of Plastic Surgery, National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh
M. Mostafizur Rahman Department of Orthopaedic Surgery, National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, Bangladesh
Enora Nilomi Department of Plastic Surgery, Enam Medical College and Hospital, Dhaka, Bangladesh
Mostakim Maria Alievna Department of Plastic Surgery, National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh
M. Ariful Islam Sumon Department of Plastic Surgery, National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh
Rayhana Awwal Department of Plastic Surgery, National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2349-2902.isj20253450

Keywords:

Oral cavity, Free flap, ALTFF, RFFF, Reconstruction, Surgical outcomes, Functional outcomes

Abstract

Background: Anterolateral thigh free flap (ALTFF) and radial forearm free flap (RFFF) are preferred for oral cavity reconstruction due to reliability, high success, and low donor-site morbidity. The aim of this study was to evaluate the early surgical and functional outcomes of ALTFF and RFFF in the reconstruction of soft tissue defects of the oral cavity.

Methods: This prospective observational study was conducted in the department of plastic surgery, NIBPS, Dhaka, from July 2020 to December 2021. A total of 20 patients who required free flap reconstruction following surgical resection of oral cavity lesions, with or without adjacent soft tissue or bone involvement, were included.

Results: The mean patient age was 54.8±8.48 years, with a female predominance (60%). All defects were in the cheek, most commonly involving the angle of the mouth (60%). ALTFF was used in 55% and RFFF in 45% of cases. Flap survival was 90.9% for ALTFF and 77.7% for RFFF. Functional outcomes were satisfactory. ALTFF donor sites were closed primarily, while RFFF donor sites required STSG, with 33.3% showing minor graft loss. Donor site morbidity was higher in RFFF cases.

Conclusions: Both ALTFF and RFFF are reliable for reconstruction of oral cavity soft tissue defects, providing high flap survival and acceptable functional results.

Metrics

Metrics Loading ...

References

Habib MA, Rahman QB, Hossain S, Imon AA, Kundu GC. Effectiveness of Preoperative Lymphoscintigraphy for the Detection of Cervical Lymph Node Metastasis in Patients with Oral Squamous Cell Carcinoma. Anna Maxillofacial Surg. 2017;7(1):30-6. DOI: https://doi.org/10.4103/ams.ams_176_16

Sah R, Akhter M. Oral Cancer Senario in Multiple Centers of Dhaka, Bangladesh. Biomed J Scientific Technical Res. 2020;32(2):24867-70. DOI: https://doi.org/10.26717/BJSTR.2020.32.005232

Rahman QB, Gautam S, Habib MA. A Study to Detect Sentinel Lymph Node by Methylene Blue Dye and Histopathological Confirmation of Metastasis in Oral Squamous Cell Carcinoma Patient. Am J Oral Maxillofacial Surg. 2018;5(1):13-21.

Ren ZH, Wu HJ, Tan HY, Wang K, Zhang S. Transfer of anterolateral thigh flaps in elderly oral cancer patients: complications in oral and maxillofacial reconstruction. J Oral Maxillofacial Surg. 2015;73(3):534-40. DOI: https://doi.org/10.1016/j.joms.2014.09.021

Suh JM, Chung CH, Chang YJ. Head and neck reconstruction using free flaps: a 30-year medical record review. Arch Craniofacial Surg. 2021;22(1):38. DOI: https://doi.org/10.7181/acfs.2020.00745

Pastars K, Zarins J, Tars J, Ivanova A, Skagers A. Microsurgical reconstruction of oral defects with free flaps for patients with oral cancer: an 8 year experience with 153 consecutive cases. Stomatologija. 2018;20(2):39-42.

Camaioni A, Loreti A, Damiani V, Bellioni M, Passali FM, Viti C. Anterolateral thigh cutaneous flap vs. radial forearm free-flap in oral and oropharyngeal reconstruction: an analysis of 48 flaps. Acta Otorhinolaryngol Italica. 2008;28(1):7-12.

Young AM, Bache S, Segaren N, Murphy S, Maraka J, Durrani AJ. Free flap selection and outcomes of soft tissue reconstruction following resection of intra-oral malignancy. Front Surg. 2019;6:53. DOI: https://doi.org/10.3389/fsurg.2019.00053

Jeremić JV, Nikolić ŽS. Versatility of radial forearm free flap for intraoral reconstruction. Srpski Arhiv Cellokupno Lekarstvo. 2015;143(5-6):256-60. DOI: https://doi.org/10.2298/SARH1506256J

Loreti A, Di Lella G, Vetrano S, Tedaldi M, Dell'Osso A, Poladas G. Thinned anterolateral thigh cutaneous flap and radial fasciocutaneous forearm flap for reconstruction of oral defects: comparison of donor site morbidity. J Oral Maxillofacial Surg. 2008;66(6):1093-8. DOI: https://doi.org/10.1016/j.joms.2007.09.021

Fang QG, Li ZN, Zhang X, Liu FY, Xu ZF, Sun CF. Clinical reliability of radial forearm free flap in repair of buccal defects. World J Surgical Oncol. 2013;11(1):1-4. DOI: https://doi.org/10.1186/1477-7819-11-26

Hashmi SS, Abbas A, Bukhari A, Saeed J, Shafqat A, Siddique AH, et al. Selective Neck Dissection for Node-Positive Oral Cavity Squamous Cell Carcinoma: A Retrospective Cohort Study. Int Arch Otorhinolaryngol. 2022;26(4):e630-5. DOI: https://doi.org/10.1055/s-0041-1741437

Hsing CY, Wong YK, Wang CP, Wang CC, Jiang RS, Chen FJ, et al. Comparison between free flap and pectoralis major pedicled flap for reconstruction in oral cavity cancer patients–a quality of life analysis. Oral Oncol. 2011;47(6):522-7. DOI: https://doi.org/10.1016/j.oraloncology.2011.03.024

Kesting MR, Hölzle F, Wales C, Steinstraesser L, Wagenpfeil S, Mücke T, et al. Microsurgical reconstruction of the oral cavity with free flaps from the anterolateral thigh and the radial forearm: a comparison of perioperative data from 161 cases. Ann Surg Oncol 2011;18(7):1988-94. DOI: https://doi.org/10.1245/s10434-011-1584-8