Comparison of Donor Site Morbidity Between Anterolateral Thigh and Radial Forearm Free Flaps for Head and Neck Reconstruction: A Systematic Review and Meta-Analysis

Abstract

This meta-analysis aimed to provide an up-to-date comparison of donor site morbidity (DSM) between patients who underwent head and neck reconstruction with Anterolateral thigh (ALT) and radial forearm free (RFF) flaps. We searched the PubMed, Web of Science, EMBASE, and Cochrane Library databases to identify studies that compared DSM between ALT and RFF patients. Study quality was assessed using the Newcastle-Ottawa Scale. The pooled odds ratio (OR) of each DSM between ALT and RFF patients was estimated using a random-or fixed-effect model depending on the degree of interstudy heterogeneity. Sensitivity and subgroup analyses were performed if substantial heterogeneity was detected. Eighteen cohort studies with 1,018 patients (535 ALT and 483 RFF patients) were included. Compared with RFF, ALT were associated with lower risks of wound dehiscence (OR ¼ 0.2, 95%CI: 0.10-0.42, P < 0.01), strength impairment (OR ¼ 0.18, 95%CI: 0.07-0.47, P < 0.01), and movement impairment (OR ¼ 0.19, 95%CI:0.07-0.49, P < 0.01). A subgroup analysis showed that ALT were associated with a lower risk of donor site numbness among patients undergoing tongue reconstruction (OR ¼ 0.05, 95%CI: 0.01-0.25, P < 0.01), but not among all patients undergoing head and neck reconstruction. The pooled ORs of other DSMs demonstrated no significant difference between ALT and RFF patients. ALT are superior to RFF for head and neck reconstruction in terms of donor site wound dehiscence, strength impairment, movement impairment, and for tongue reconstruction specifically in terms of donor site numbness. No significant differences in the incidence of donor site hematoma/seroma, infection, or dissatisfaction with donor site appearance were identified between ALT and RFF patients.

Comparative Study of the Morphological Characteristics of Perforators of the Transverse and Descending Branches of the Lateral Circumflex Femoral Artery in Anterolateral Thigh Flap Surgery

“…Above all, the damage caused by flap harvest surgery using this approach to the vastus lateralis muscle is inevitable, and it can induce functional disturbance and significant donor site complications. 15,16 Direct cutaneous perforators account for most perforators originating from the LCFA-tb. The flap based on direct cutaneous perforators can be raised most simply without entering any muscle substance, and thus, less muscle damage yields better functional preservation.…”

“…Musculocutaneous perforators are difficult to operate on, and the perforator in the vastus lateralis muscle needs to be dissected; thus, the operation time needs to be extended, and the incidence of several complications is likely increased. Above all, the damage caused by flap harvest surgery using this approach to the vastus lateralis muscle is inevitable, and it can induce functional disturbance and significant donor site complications 15,16 . Direct cutaneous perforators account for most perforators originating from the LCFA-tb.…”

Robot-assisted radial forearm free flap harvesting: a propensity score-matched case–control study

“…Some surgeons prefer anterolateral thigh and latissimus dorsi aps over radial forearm ap for soft tissue reconstruction in head and neck area because donor site repair can be done by primary closure [12]. Also, it is thought that younger patients who are sensitive to aesthetic outcome will prefer anterolateral thigh ap because the scar can be hidden [13].…”

The Use of Three Iliac Crest Muscles for Head and Neck Soft Tissue Reconstruction: Technical Note

“…The anterolateral thigh flap has several advantages, such as the size of the skin paddle and pedicle; it also has disadvantages such as visible scarring, risk of pilosity, and excessive thickness. 4,5 The anterolateral thigh flap can be used for aesthetic and functional reconstruction of the tongue. 6 The medial sural artery perforator flap is a fair option for head and neck reconstruction with low donor site morbidity, and the ability to raise a large skin paddle.…”