Anterolateral thigh, radial forearm and superficial circumflex iliac perforator flaps in oral reconstruction: a comparative analysis

Abstract

Background: Anterolateral thigh (ALT) and Radial forearm free flaps (RFFF) are historically the most common methods of oral reconstruction. The Superficial circumflex iliac artery perforator flap (SCIP) is an alternative providing a donor site that can be readily closed primarily with improved cosmesis in younger patients, due to its concealability. Methods: We reviewed 135 patients who received ALT, RFFF or SCIP flaps for oral reconstruction in our institution. Our aim was to compare operative and perioperative outcomes between each cohort. ANOVA and χ 2 test were used for statistical analysis. Results: There were 37 ALT, 64 RFFF and 35 SCIP reconstructions. Patients reconstructed with SCIP flaps had smaller resection volumes (P < 0.001) and earlier T and N classifications (P = 0.001, P = 0.008), and consequently reduced tracheostomy rates (P < 0.001), reduced need for enteral feeding at discharge (P < 0.001) and shorter length of stay and perioperative times (P < 0.001). SCIP flaps were more common in younger patients (P < 0.01). ALT flaps were used for more advanced disease (P = 0.001) and had larger resection volumes (P < 0.001) and increased need for assisted enteral feeding (P < 0.001). There were no significant differences in flap or donor site outcomes. There were two flap failures, both RFFF. Conclusion: Each flap plays an important role in the reconstruction of oral defects, with larger defects preferentially reconstructed with ALT flaps. SCIP appears to be a reliable alternative in small defects with excellent perioperative and postoperative outcomes.

Algorithm for the reconstruction of the parotid region: a single institution experience

“…This could be attributed to the advancements in microsurgery and the maturation of vascular anastomosis techniques, which have provided greater flexibility and advantages to free flaps over pedicled pectoralis major muscle flaps. Additionally, forearm flaps may not offer sufficient soft tissue volume so that narrow indications of the reconstruction requirements for this region [ 24 ]. Therefore, for large defects in the parotid region, we highly recommend the use of anterolateral thigh muscle flaps, skin flaps, or chimeric perforator myocutaneous flaps for reconstruction.…”

Trends in free flap reconstruction of the head and neck: a single surgeon series of 1027 free tissue transfers

“…Despite the reduction in smoking, the rate of oral cancer continues to rise in Australia for unknown reasons, particularly in young females 16 . This has driven the use of low morbidity, cosmetically sensitive flaps for oral reconstruction such as the SCIP which provides a unique combination of mobile adipose tissue with thin flexural skin 17 …”

“…16 This has driven the use of low morbidity, cosmetically sensitive flaps for oral reconstruction such as the SCIP which provides a unique combination of mobile adipose tissue with thin flexural skin. 17…”

“…This has changed referral patterns and influenced the flap choice in ways that are unlikely to be representative of other tertiary and quaternary referral institutions. They have also used reconstructive approaches that are not routinely employed by all institutions including dynamic facial reanimation using the chimeric VALT, 11,12,33 scapular flaps for osseous reconstruction, 31,32 the SCIP flap for oral reconstruction, 17,34 fascial flaps such as the TPF flap for laryngotracheal reconstruction and osteoradionecrosis, [35][36][37] and point-of-care VSP with primary dental implants for maxillomandibular reconstruction. [18][19][20][21][22][23][24][26][27][28][29][30][31][32]38…”

Survival of Dental Implants Placed in Iliac, Fibula, and Radial Forearm Flaps: A Comprehensive Review

“…Moreover, Papanikolas et al explained that each type of flap serves a crucial purpose in repairing oral defects, with anterolateral thigh flaps being the preferred choice for larger defects. However, for smaller defects, the superficial circumflex iliac artery perforator (SCIP) flap is a dependable alternative that yields outstanding results before and after surgery [ 32 ]. De Santis et al explained that the prelaminated fasciomucosal radial forearm free flap is a viable choice for reconstructing the tip of the tongue, particularly in specific cases that prioritize clear speech and proper articulation [ 33 ].…”