Comparison between free posterior tibial flap and free radial forearm flap for head and neck reconstruction: an anatomical study and a retrospective comparative cohort study

Abstract

Background: Both free posterior tibial flap (FPTF) and free radial forearm flap (FRFF) are commonly used for head and neck defects. They have many similarities in embryology, histology, and anatomy, but their advantages and disadvantages in head and neck repair have not been fully recognized. This study aimed to compare the cadaveric anatomy and clinical application of FPTF and FRFF for the reconstruction of head and neck defects after tumor resection.Methods: Anatomical dissection was performed on 10 fresh adult cadavers. The general characteristics of both flaps and the sites of recipients and donors were collected. A total of 31 and 25 patients underwent FPTF and FRFF construction, respectively. The patient medical records were assessed to obtain the clinical characteristics. Characteristics of the flap such as size, pedicle length, and clinical process data were collected and compared. The appearance, sensory disturbance, and effect on quality of life and daily activity were evaluated.Results: The posterior tibial artery was present and observed in all patients. The posterior vascular pedicle was longer than the radial artery. There was no difference between the diameters of arteries of FPTF and FRFF; however, the diameters of their veins differed. In terms of flap characteristics, FPTF was significantly larger and had a longer vascular pedicle than FRFF (40.68±11.07 vs. 53.77±29.02 cm 2 , P=0.03; 8.48±1.66 vs.

Aesthetic Considerations of Simultaneous Reconstruction With Free Flap for Local Advanced Hypopharyngeal Combined With Cervical Esophageal Cancer

“…The general principles of plastic surgery were initially and systematically defined at the beginning of the development of modern head and neck oncology, and these principles were further elaborated and developed in surgery involving facial and neck tumors, the most exposed areas of the human body. [1][2][3][4] After achieving local-regional control and long-term survival of the tumor, patients will inevitably demand higher quality of life, including aesthetic appearance of the surgical area. This is mainly reflected in the requirement that the incision should be small and concealed, that the reconstructed tissue should have the same color and fullness as the original anatomical site, and that damage to the appearance and function of the flap donor site should be minimized.…”

“…The general principles of plastic surgery were initially and systematically defined at the beginning of the development of modern head and neck oncology, and these principles were further elaborated and developed in surgery involving facial and neck tumors, the most exposed areas of the human body 1–4 . After achieving local-regional control and long-term survival of the tumor, patients will inevitably demand higher quality of life, including aesthetic appearance of the surgical area.…”

“…A free flap either from anterior lateral or medial thigh with thick subcutaneous fat (at least ≥1 cm) was harvested. The flap area ranged from 56 to 72 cm 2 with the median area 63 cm 2 .…”

“…With the help of adequate-designed flap, satisfactory morphological and functional reconstruction could be achieved; meanwhile, the aesthetics of the donor site could also been emphasized. [1][2][3] As we have noticed that different free flap shape and thickness could be used to obtain different neck contour in the flap transfer practice, 21 cases of local advanced hypopharyngeal combined and cervical esophageal cancer patients with free thigh flap reconstruction was reviewed for a better understanding of the corresponding aesthetic results.…”

“…These kinds of deformities might arouse some aesthetic requirements in the patients, especially male patients with laryngeal prominence as a sex marker. With the help of adequate-designed flap, satisfactory morphological and functional reconstruction could be achieved; meanwhile, the aesthetics of the donor site could also been emphasized 1–3 …”