Comparison of the Radial Forearm Flap and the Thinned Anterolateral Thigh Cutaneous Flap for Reconstruction of Tongue Defects: An Evaluation of Donor-Site Morbidity

Abstract

The radial forearm flap is commonly used for reconstruction of tongue defects following tumor extirpation. This flap is easy to harvest and offers thin tissue with large-caliber vessels. However, its use leaves behind a conspicuous aesthetic deformity in the forearm and requires the sacrifice of a major artery of that limb, the radial artery. The anterolateral thigh cutaneous flap has found clinical applications in the reconstruction of soft-tissue defects requiring thin tissue. More recently, in a thinned form, the anterolateral thigh flap has been used for reconstructing defects of the tongue with functional results equivalent to that of the radial forearm flap. For the reconstruction of tongue defects, these two flaps could provide similar soft-tissue coverage, but they seem to result in different donor-site appearances. The donor site is closed primarily, leaving only a linear scar that is inconspicuous with normal clothing, and no functional deficit is left behind in the thigh. Thus, for the supply of flaps for tongue defects, a comparison between the radial forearm flap and the anterolateral thigh flap donor sites is provided in this study. Between December of 2000 and August of 2002, 41 patients who underwent reconstruction of defects of the tongue using either a radial forearm flap or an anterolateral thigh flap were evaluated. The focus was on the evaluation of the functional and aesthetic outcome of the donor site after harvesting these flaps for the purpose of reconstructing either total or partial tongue defects. Finally, a comparison was performed between the donor sites of the two flaps. The disadvantages of the radial forearm flap include the conspicuous unattractive scar in the forearm region, pain, numbness, and the sacrifice of a major artery of the limb. In some patients, the donor-site scar of the forearm acted as a social stigma, preventing these patients from leading a normal life. In contrast, the anterolateral thigh cutaneous flap, after thinning, achieved the same results in reconstructing defects of the tongue without the associated donor-site morbidity. Most importantly, the donor site in the thigh could be closed primarily in almost all patients without any functional deficit. The thinned anterolateral thigh cutaneous flap is a viable substitute for the radial forearm flap when reconstructing defects of the tongue. The results achieved are similar to those of the radial forearm flap, and the donor-site morbidity is significantly decreased.

Functional and Aesthetic Reconstruction of the Defects Following the Hemiglossectomy in Patients with Oropharyngeal Cancer

“…Concerning the question as to what is the best flap (radial forearm, anterolateral thigh, or deep inferior epigastric flap) for the reconstruction after hemiglossectomy, majority of recent papers suggest that the use of anterolateral thigh flap is the best option because the anterolateral thigh flap provide as good postoperative results as forearm flap whereas the former has less donor site morbidity than latter does [2][3][4][5]. We generally agree with them.…”

“…Regarding the volume of the flap for the defects of hemiglossectomy, there was some reports that discuss whether the reconstruction with flap is necessary or not [10,11], but most papers describe that reconstruction with free flap provide good functional results [1][2][3][4][5][6][7][8][9]. The flaps seen in these papers are comparatively large, and the size of reconstructed tongues is as large as that of original tongue.…”

“…Actually, many reports have described that the functional results are generally good after the reconstruction with flaps following hemiglossectomy [1][2][3][4][5][6][7][8][9]. However, it is rather difficult to perform the reconstruction that makes the best of remaining tissue and function.…”

A systematic review of anterolateral thigh flap donor site morbidity

“…The popularity of the 'work-horse' ALT flap is often attributed to its multiple advantages, which can be divided into three categories: pedicle, flap design and operative technique (1,2,6,7,13,14,21,26,38,(44)(45)(46). With regard to the pedicle, the ALT flap has a long pedicle with good calibre, which can be located and dissected out before committing to the final flap design.…”

“…T he anterolateral thigh (ALT) flap, first described as a septocutaneous perforator-based flap by Song et al (1) in 1984, has recently gained popularity and has become an important option for reconstruction of multiple anatomical locations such as the head and neck (3)(4)(5)(6)(7)9,10,(12)(13)(14)16,(18)(19)(20)(21)(22)(23)(25)(26)(27)(28)(29)(30)32,34,36,38,39,(41)(42)(43), upper (15)(16)(17)(18)(19)26,32,35,37,38,42) and lower (8,(16)(17)(18)(19)22,24,…”