Introduction: Functional reconstruction of defects of the head and neck area is a challenging problem. To reconstruct defects, several surgical techniques have been used. The radial forearm free flap (RFFF) is the most frequent choice. However, the RFFF has some limitation, therefore to reconstruct extensive defects; we have used the anterolateral thigh free flap (ALTF). We have compared patient data after reconstructions of the head and neck area using the RFFF or ALTF.
Method: Retrospective data of 200 oral and oropharyngeal cancer patients with RFFF (158) and ALTF (42) reconstructions were reviewed and statistically analyzed for the following characteristics between 1994 and 2016 at a single-institution was conducted. The VFSS (Video fluoroscopic swallowing study) and speech evaluation (Correct consonants and speech intelligibility) were used to objectively assess the functional outcomes. VFSS was performed in all patients, but the speech test was performed in 65 of 158 patients with RFFF group and 25 of 42 patients with ALTF group.
Result: All patients with oral and oropharyngeal cancer underwent open surgical resection and RFFF or ALTF reconstruction at the time of surgery. The cancer type of 175 (87.5%) patients was squamous cell carcinoma. RFFF was used in order of oropharynx (n=84) and oral cavity (n=74). ALTF was used in order of oral cavity (n=30) and oropharynx (n=12). The mean flap area was higher in ALTF than in RFFF (122.39? vs 62.57?; p < 0.001). Penetration-Aspiration Scale(PAS) was significantly lower in RFFF reconstructions (1.99±1.256 vs 2.92±1.832; p < 0.001). Correct consonants and speech intelligibility were significantly higher in RFFF group. (60.68%±21.386 vs 52.17%±16.561; p = 0.041, 56.99%±21.292 vs 45.64%±13.766; p = 0.014).
Conclusion: Functional evaluations of RFFF group showed a more significant decrease in aspiration and improve in speech than ALTF group. ALTF can use bigger defect, about 2 times larger resections than RFFF. It is more important that the type of flap is determined according to the defect site and extent. RFFF has better function results than ALTF in small to moderate size defects especially in the oral cavity and oropharyngeal reconstruction.