Comparison of Current Free Flap Options for Intraoral Lining and Tongue Reconstruction

Abstract

Free flaps have become the main alternative for intraoral reconstruction in current practice. However, controversy exists on pros and cons of different free flap options for this challenging area. Although there are various studies focusing on different free flap options, comparative studies are very few and there is not a single study comparing all 4 thin free flap options for intraoral reconstruction. Between 2018 and 2021, 30 patients underwent intraoral reconstruction. Four pliable and thin flaps, medial sural artery perforator flap, superficial circumflex iliac artery perforator flap, radial forearm free flap, and superthin anterolateral thigh flap were used for reconstructions and compared per functionality and patients’ quality of life. One medial sural artery perforator flap and 1 superficial circumflex iliac artery perforator flap failed because of perfusion problems, and the remaining flaps survived. Harvest time and donor site closure were with significant difference (P<0.05) between groups. Quality of life results were similar except one of the disease-specific questions. In authors’ opinion, anterolateral thigh flap is the best option in normal-weight individuals because of its reliability, pliability, and constant reliable vascular structure. Although other options may be considered in overweighted patients, thinly elevated anterolateral thigh flap still seems to be the most reliable option.

The use of chimeric‐superthin anterolateral thigh flap in reconstruction of laryngopharyngoesophagectomy defects of hypopharyngeal cancer

“…While the superthin flaps have been used especially for extremities (Diamond et al, 2018) and other head and neck (Bali, Karatan, et al, 2021; Gur et al, 2022) reconstructions, there is still no consensus on what to do for pharyngoesophageal reconstructions in cases with bulky ALT. Some authors preferred or suggested to use RFFF when the ALT was bulky in overweight patients (Nagel & Hayden, 2014; Sharaf et al, 2017) for pharyngoesophageal reconstruction.…”

“…However, the potential risk is perfusion problems when thinning procedure is chosen in the literature. On the other hand, it has been used for different kind of defects of the body successfully in the literature (Bali, Ozkan, et al, 2021) While the superthin flaps have used especially for extremities (Diamond et al, 2018) and other head and neck (Bali, Karatan, et al, 2021;Gur et al, 2022) reconstructions, there is still no consensus on what to do for pharyngoesophageal reconstructions in cases with bulky ALT. Some authors preferred or suggested to use RFFF when the ALT was bulky in overweight patients (Nagel & Hayden, 2014;Sharaf et al, 2017) for pharyngoesophageal reconstruction.…”

Radial Forearm Free Flap for Head and Neck Defect Reconstruction: An Up-to-date Review of the Literature

“…Gur et al compared current free flap options for intraoral lining and tongue reconstruction. The author suggested that the anterolateral thigh flap is considered the best choice in an average-weight person due to its pliability, reliability, and constant vascular structure [25]. Demonstration of the postoperative view is shown in Figure 4.…”

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

“…The author suggested that employing full-thickness skin grafts for the donor site reconstruction of the forearm free flap provides superior aesthetic outcomes without the morbidity associated with split-thickness skin grafts [ 44 ]. In a study by Gur et al, different free flap options for intraoral lining and tongue reconstruction were compared, with the author recommending the anterolateral thigh flap as the most suitable choice for average-weight individuals due to its pliability, reliability, and consistent vascular structure [ 45 ].…”