Though dextran 40 did not result in any significant adverse local or systemic complications, it is not useful as a postoperative antithrombotic agent in head and neck oncologic reconstruction with free tissue transfer.

The anterolateral thigh (ALT) free flap was first described in 1984 by Song et al. 1 Wei et al popularized this flap. 2 They reported 672 cases of ALT flap reconstruction with minimal failure rate (2% total and 3% partial failure). Kimata et al described the versatility of the flap in head and neck reconstruction and also noted that the donor site morbidity is minimal. 3,4 An ideal soft tissue free flap for head and neck reconstruction should have the following characteristics, versatility in design, adequate tissue, appropriate texture, minimal donor site morbidity, availability of diverse tissue types on one pedicle, potential for reinnervations, long pedicle, feasibility of a two team approach, and consistent anatomy for easy and safe flap dissection. 5-7 Except for the latter, the ALT flap has been suggested to have all the qualities. The purpose of this article is to discuss the various reconstructive indications, outcome, and morbidity of ALT flap reconstruction in head and neck. MethodsThis is a retrospective study of 194 consecutive ALT free flaps used for head and neck reconstruction in a tertiary level Keywords ► head and neck cancer ► head and neck reconstruction ► anterolateral thigh flap ► oromandibular defect ► free flaps AbstractAnterolateral thigh (ALT) free flap is a common flap with multitude of indications. The purpose of this article is to review the reconstructive indications of the flap in head and neck defects. This is a retrospective study of 194 consecutive ALT flaps. Data including patient characteristics (age, sex, comorbidities), disease characteristics (histology, T stage), and flap characteristics (size of the flap, type of closure of ALT donor site) were collected. The outcome in terms of flap success rate, surgical, and donor site morbidity were studied. A total of 194 flaps were performed in 193 patients over a period of 10 years. Mean age of the patients was 55 years (range 16-80 years). Out of the 193 patients, 91 (47.1%) patients had oromandibular defects, 52 (26.9%) had tongue defects, 15 (7.7%) had pharyngeal defects, 17 (8.8%) had skull base defects, 4 (2%) had scalp defects, and 14 (7.2%) had contour defects of the neck. The overall flap success rate was 95.8% (8 total flap loss out of 194). Hypertrophic scar was the commonest donor site problem seen in 20 (10.3%) patients. This study shows the versatility of free ALT flap in head and neck reconstruction. It is a reliable and safe. Donor site morbidity is minimal.

This reconstructive technique enabled us to maintain the integrity of the subglottic airway. Our technique was unique in that we used the skin-lined part of the radial forearm flap to line the airway and the fascia to cover the titanium mesh outside, thereby preventing plate exposure.

Neck dissection leaves behind an aesthetically unacceptable scar over front of the neck. Various techniques, both endoscopic and robotic, have been tried to avoid this scar. Though comparatively more cases of robotic surgery are reported than endoscopic neck dissection, the cost and availability of robot precludes many patients from getting the benefit of minimally invasive neck dissection (MIND). We performed minimally invasive neck dissection for two carefully selected patients with early oral cancer and cN0. We used standard endoscopic equipment and ubiquitously available laparoscopic ports. We used gas insufflation to create the working space. Our results show that MIND is feasible and oncologically safe. The scars produced are aesthetically better than that of conventional open neck dissection. This procedure leaves no scars in the anterior aspect of the neck. This technique can be replicated at any center with endoscopic equipments without need for purchasing specialised retractors or a robot.