Mohammad, N., Hasanein, M., Saied, S., Abdelmegeed, A. (2021). Comparaison between Radial Forearm Free Flap (RFFF) and Anterolateral Thigh (ALT) Flap in Head and Neck Reconstruction. The Egyptian Journal of Plastic and Reconstructive Surgery, 45(4), 281-289. doi: 10.21608/ejprs.2021.201648
Noha Osman a Mohammad; Mohammed A Hasanein; Samia M. A. Saied; Ahmed G. Abdelmegeed. "Comparaison between Radial Forearm Free Flap (RFFF) and Anterolateral Thigh (ALT) Flap in Head and Neck Reconstruction". The Egyptian Journal of Plastic and Reconstructive Surgery, 45, 4, 2021, 281-289. doi: 10.21608/ejprs.2021.201648
Mohammad, N., Hasanein, M., Saied, S., Abdelmegeed, A. (2021). 'Comparaison between Radial Forearm Free Flap (RFFF) and Anterolateral Thigh (ALT) Flap in Head and Neck Reconstruction', The Egyptian Journal of Plastic and Reconstructive Surgery, 45(4), pp. 281-289. doi: 10.21608/ejprs.2021.201648
Mohammad, N., Hasanein, M., Saied, S., Abdelmegeed, A. Comparaison between Radial Forearm Free Flap (RFFF) and Anterolateral Thigh (ALT) Flap in Head and Neck Reconstruction. The Egyptian Journal of Plastic and Reconstructive Surgery, 2021; 45(4): 281-289. doi: 10.21608/ejprs.2021.201648
Comparaison between Radial Forearm Free Flap (RFFF) and Anterolateral Thigh (ALT) Flap in Head and Neck Reconstruction
The Department of Plastic Surgery, Faculty of Medicine, Sohag University
Abstract
This is a prospective comparative study that aimed to compare two techniques for reconstruction of head and neck defects resulting from different causes in different ages, the radial forearm free flap (RFFF) and the anterolateral thigh flap (ALTF). Setting: The Plastic Surgery Department of Sohag University Hospitals. Patients and Methods: For this purpose, 18 patients with head and neck defects were recruited from the attendants of The Plastic Surgery Department, Sohag University Hospital during the period from January 2019 to January 2021 with head and neck defects of different causes and were divided into 2 groups; group A included 10 patients for whom anRFFF was done for reconstruction and group B (8 patients), for whom the free ALT flap was done to reconstruct their defects. Results: The mean age for the whole group (mean ± SD) was 42.7±27 years. However, patients in group A were significantly older than those in group B (59.1±18.5 versus 22.5±20.9 years respectively, p < 0.001). The commonest cause was excision of malignant tumors (10 cases) followed by traumatic defects (7 cases) and 1 case of Romberg's disease. The overall success rate was 72.2% (11 fully survived flaps and 1 case of peripheral necrosis) while 5 cases were lost to follow-up (27.8%). The overall complication rate was 55.6% (10 cases): 70% (7 cases) in group A 37.5% (3 cases) in group B. The follow-up period ranged from 6 months to 1 year for both groups. Conclusion: The RFFF is preferred in the elderly and the ALT in the younger age group with care of venous drainage either by a large caliber vein or double vein drainage. Key Words: Radial forearm free flap – Anterolateral thigh flap – Head and neck.
Gerressen M., Pastaschek C.I., Riediger D., Hilgers RD., Hölzle F., Noroozi N., et al.: Microsurgical free flap reconstructions of head and neck region in 406 cases: A 13-year experience. Journal of Oral and Maxillofacial Surgery, 71 (3): 628-35, 2013. 2- Markey J., Knott P.D., Fritz M.A. and Seth R.: Recent advances in head and neck free tissue transfer. Curr. Opin. Otolaryngol. Head Neck Surg., 23 (4): 297-301, 2015. 3- van Gijn D.R., D'Souza J., King W. and Bater M.: Free Flap Head and Neck Reconstruction with an Emphasis on Post-operative Care. Facial Plast. Surg., 34 (6): 597- 604, 2018. 4- Demirkan F., Chen H-C., Wei F-C., Chen H-H., Jung SG., Hau S-P., et al.: The versatile anterolateral thigh flap: a musculocutaneous flap in disguise in head and neck reconstruction. British Journal of Plastic Surgery, 53 (1): 30-6, 2000. 5- Evans G.R., Schusterman M.A., Kroll S.S., Miller M.J., Reece G.P., Robb G.L., et al.: The radial forearm free flap for head and neck reconstruction: A review. The American Journal of Surgery, 168 (5): 446-50, 1994. 6- Guofan Y., Baoqui C. and Yuzhi G.: Forearm free skin flap transplantation. National Medical Journal of China, 61: 139, 1981. 7- Song Y-G., Chen G-Z. and Song Y-L.: The free thigh flap: A new free flap concept based on the septocutaneous artery. British Journal of Plastic Surgery, 37 (2): 149-59, 1984. 8- Wong C.H. and Wei F.C.: Anterolateral thigh flap. Head Neck, 32 (4): 529-40, 2010. 9- Muhlbauer W., Herndl E. and Stock W.: The forearm flap. Plast. Reconstr. Surg., 70 (3): 336-44, 1982. 10- Ahmad F.I., Means C., Labby A.B., Troob S.H., Gonzalez J.D., Kim M.M., et al.: Osteocutaneous radial forearm free flap in nonmandible head and neck reconstruction. Head Neck, 39 (9): 1888-93, 2017. 11- Chen H., Ganos D.L., Coessens B.C., Kyutoku S. and Noordhoff M.S.: Free forearm flap for closure of difficult oronasal fistulas in cleft palate patients. Plastic and Reconstructive Surgery, 90 (5): 757-62, 1992. 12- Dewey E.H., Roche A.M., Lazarus C.L. and Urken M.L.: Total lower lip and chin reconstruction with radial forearm free flap: A novel approach. Am. J. Otolaryngol., 38 (5): 618-25, 2017. 13- Hentz V.R., Pearl R.M., Grossman J.A., Wood M.B. and Cooney W.P.: The radial forearm flap: A versatile source of composite tissue. Ann. Plast. Surg., 19 (6): 485-98, 1987. 14- Oranges C.M., Ling B., Tremp M., Wettstein R., Kalbermatten D.F. and Schaefer D.J.: Comparison of anterolateral thigh and radial forearm free flaps in head and neck reconstruction. In vivo., 32 (4): 893-7, 2018. 15- Ahmed T.I. and Ismail A.: The free fascial forearm flap. Microsurgery, 10 (3): 155-60, 1989. 16- Chen H.C., Ganos D.L., Coessens B.C., Kyutoku S. and Noordhoff M.S.: Free forearm flap for closure of difficult oronasal fistulas in cleft palate patients. Plast. Reconstr. Surg., 90 (5): 757-62, 1992. 17- Fenton O.M. and Roberts J.O.: Improving the donor site of the radial forearm flap. Br. J. Plast. Surg., 38 (4): 504- 5, 1985. 18- Harii K., Ebihara S., Ono I., Saito H., Terui S. and Takato T.: Pharyngoesophageal reconstruction using a fabricated forearm free flap. Plastic and Reconstructive Surgery, 75 (4): 463-76, 1985. 19- Jani K., Maharaja N., Akali N.R., Balasubramanian D., Ramu J., Mathew J., et al.: Long-Term Patient-Reported Outcomes of Radial Forearm Free Flap Donor Site in the Context of Head and Neck Cancer Reconstruction. Indian Journal of Surgical Oncology, 1-4, 2019. 20- Safak T. and Akyürek M.: Free transfer of the radial forearm flap with preservation of the radial artery. Annals of Plastic Surgery, 45 (1): 97-9, 2000. 21- Timmons M., Missotten F., Poole M. and Davies D.: Complications of radial forearm flap donor sites. British Journal of Plastic Surgery, 39 (2): 176-8, 1986. 22- Chana J.S. and Wei F.C.: A review of the advantages of the anterolateral thigh flap in head and neck reconstruction. Br. J. Plast. Surg., 57 (7): 603-9, 2004. 23- Koshima I.: Free Anterolateral Thigh Flap for Reconstruction of Head and Neck Defects following Cancer Ablation by Shyh-Jou Shieh, MD, Haw-Yen Chiu, MD, Jui-Chin Yu, MD, Shin-Chen Pan, MD, Sen-Tien Tsai, MD, and Egypt, J. Plast. Reconstr. Surg., October 2021 289 Ching-Liang Shen, Ph. D. Plastic and reconstructive surgery, 105 (7): 2358-60, 2000. 24- Koshima I., Fukuda H., Yamamoto H., Moriguchi T., Soeda S. and Ohta S.: Free anterolateral thigh flaps for reconstruction of head and neck defects. Plastic and Reconstructive Surgery, 92 (3): 421-8; discussion 9-30, 1993. 25- Wolff K-D., Kesting M., Thurmüller P., Böckmann R. and Hölzle F.: The anterolateral thigh as a universal donor site for soft tissue reconstruction in maxillofacial surgery. Journal of Cranio-Maxillofacial Surgery, 34 (6): 323-31, 2006. 26- Chen C-M., Chen C-H., Lai C-S., Lin S-D., Huang I-Y. and Shieh T-Y.: Anterolateral thigh flaps for reconstruction of head and neck defects. Journal of Oral and Maxillofacial Surgery, 63 (7): 948-52, 2005. 27- Kimata Y., Uchiyama K., Ebihara S., Yoshizumi T., Asai M., Saikawa M., et al.: Versatility of the free anterolateral thigh flap for reconstruction of head and neck defects. Archives of Otolaryngology-Head & Neck Surgery, 123 (12): 1325-31, 1997. 28- Farace F., Fois V.E., Manconi A., Puddu A., Stomeo F., Tullio A., et al.: Free anterolateral thigh flap versus free forearm flap: Functional results in oral reconstruction. J. Plast. Reconstr. Aesthet Surg., 60 (6): 583-7, 2007. 29- Li W., Xu Z., Liu F., Huang S., Dai W. and Sun C.: Vascularized free forearm flap versus free anterolateral thigh perforator flaps for reconstruction in patients with head and neck cancer: Assessment of quality of life. Head Neck, 35 (12): 1808-13, 2013. 30- Knott P.D., Seth R., Waters H.H., Revenaugh P.C., Alam D., Scharpf J., et al.: Short-term donor site morbidity: A comparison of the anterolateral thigh and radial forearm fasciocutaneous free flaps. Head Neck, 38 (Suppl 1): E945-8, 2016. 31- Liu W.W., Li H., Guo Z.M., Zhang Q., Yang A.K., Liu X.K., et al.: Reconstruction of soft-tissue defects of the head and neck: Radial forearm flap or anterolateral thigh flap? Eur. Arch. Otorhinolaryngol., 268 (12): 1809-12, 2011. 32- Valentini V., Cassoni A., Marianetti T.M., Battisti A., Terenzi V. and Iannetti G.: Anterolateral thigh flap for the reconstruction of head and neck defects: Alternative or replacement of the radial forearm flap? Journal of Craniofacial Surgery, 19 (4): 1148-53, 2008. 33- Lakhiani C., Lee M.R. and Saint-Cyr M.: Vascular anatomy of the anterolateral thigh flap: A systematic review. Plastic and Reconstructive Surgery, 130 (6): 1254-68, 2012. 34- Lim S., Atwi N., Long S., Toshav A. and Lau F.H.: Variations in the anterolateral thigh flap's vascular anatomy in African Americans. Journal of reconstructive microsurgery, 34 (04): 300-6, 2018. 35- Quilichini J., Benjoar M.D., Hivelin M., Brugel L. and Lantieri L.: Semi-free radial forearm flap for head and neck reconstruction in vessel-depleted neck after radiotherapy or radical neck dissection. Microsurgery, 32 (4): 269-74, 2012. 36- De Witt C.A., De Bree R., Verdonck-de Leeuw I.M., Quak J.J. and Leemans C.R.: Donor site morbidity of the fasciocutaneous radial forearm flap: What does the patient really bother? European archives of oto-rhino-laryngology, 264 (8): 929-34, 2007. 37- Chang S.C.N., Miller G., Halbert C.F., Yang K.H., Chao W.C. and Wei F.C.: Limiting donor site morbidity by suprafascial dissection of the radial forearm flap. Microsurgery: Official Journal of the International Microsurgical Society and the European Federation of Societies for Microsurgery, 17 (3): 136-40, 1996. 38- Lutz B.S., Wei F-C., Chang SC., Yang K-H. and Chen IH.: Donor site morbidity after suprafascial elevation of the radial forearm flap: A prospective study in 95 consecutive cases. Plastic and Reconstructive Surgery, 103 (1): 132-7, 1999. 39- Novak C.B., Lipa J.E., Noria S., Allison K., Neligan P.C. and Gilbert R.W.: Comparison of anterolateral thigh and radial forearm free flap donor site morbidity. Microsurgery: Official Journal of the International Microsurgical Society and the European Federation of Societies for Microsurgery, 27 (8): 651-4, 2007. 40- Zhang Y.X., Xi W., Lazzeri D., Zhou X., Li Z., Nicoli F., et al.: Bipaddle radial forearm flap for head and neck reconstruction. Journal of Craniofacial Surgery, 26 (2): 350-3, 2015. 41- Sadove R.C., Luce E.A. and McGrath P.C.: Reconstruction of the lower lip and chin with the composite radial forearmpalmaris longus free flap. Plastic and Reconstructive Surgery, 88 (2): 209-14, 1991.
View on SCiNiTO
Top