CAN THE ANTEROLATERAL THIGH FLAP REPLACE THE RECTUS ABDOMINIS FREE FLAP IN THE RECONSTRUCTION OF COMPLEX MAXILLARY DEFECTS?
AbstractAbstract :Background/Objective :The aim of this study is to compare the Anterolateral Thigh Flap(ALTF) to the standard option like the Rectus Abdominis Free Flap(RAMFF) for the reconstruction of complex maxillary defects. Materials and Methods:This study was conducted at the Department of Plastic and Reconstructive Surgery, Shifa International Hospital Islamabad, Pakistan. In the past 08 years between 2009 to 2016 patients of all age groups with complex maxillectomy defects, (Type III and IV according to Cordeiro classification) resulting from tumour resection, trauma, osteoradionecrosis or infection, underwent reconstruction with the free anterolateral thigh flap and the rectus abdominis free flap. All the patients with tumours were discussed in the head & neck multidisciplinary team meeting. Results:Over a period of 8 years, 49 Rectus Abdominis free flaps and 32 Anterolateral thigh free flaps were performed for reconstruction of Type III and IV maxillectomy defects. The predominant cause of the defects was tumour excision followed by defects resulting from mucormycosis. The patients’ ages ranged from 6 to 80 years. The follow up was weekly for 1 month and then 3 monthly for the 1st year, 6 monthly for 2nd year and then yearly. All the patients had an uneventful immediate recovery. There were increase incidence of donor site morbidity in the RAMFF group as compared to the ALTF group. There was 1 flap loss in the RAMFF group series. Conclusions :Our experience suggests that the ALTF has advantages over the RAMFF in terms of the donor site morbidity, operative time and postoperative recovery in the reconstruction of complex maxillectomy defects. Keywords: Microvascular maxillary reconstruction, Cordeiro Type III Maxillary defect, Cordeiro Type IV Maxillary defect, Free flaps Complications. Anterolateral Thigh free flap, Rectus Abdominis free flap.Background: Maxilla is perhaps the most essential and visible part of the mid-face. It is a three-dimensional structure and when reconstructing maxillectomy defects the principles of aesthetics as well as the best functional outcomes are taken into account. The aim of this study is to compare the Anterolateral Thigh Flap (ALTF) to the standard option like the Rectus Abdominis Free Flap (RAMFF) for the reconstruction of complex maxillary defects. Methods: This descriptive case series was conducted at the Department of Plastic and Reconstructive Surgery, Shifa International Hospital Islamabad, Pakistan from 2009 to 2016. Patients of all age groups with complex maxillectomy defects, (Type III and IV according to Cordeiro classification) resulting from tumour resection, trauma, osteoradionecrosis or infection, underwent reconstruction with the free anterolateral thigh flap and the rectus abdominis free flap. Results: Over a period of 8 years, 49 Rectus Abdominis free flaps and 32 Anterolateral thigh free flaps were performed for reconstruction of Type III and IV maxillectomy defects. The follow up was weekly for 1 month and then 3 monthly for the 1st year, 6 monthly for 2nd year and then yearly. All the patients had an uneventful immediate recovery. Conclusion: ALTF has advantages over the RAMFF in terms of the donor site morbidity, operative time and postoperative recovery in the reconstruction of complex maxillectomy defects.Keywords: Microvascular maxillary reconstruction; Cordeiro Type III Maxillary defect; Cordeiro Type IV Maxillary defect; Free flaps Complications; Anterolateral Thigh free flap; Rectus Abdominis free flap.
Cordeiro PG, Santamaria E. A classification system and algorithm for reconstruction of maxillectomy and midfacial defects. Plast Reconstr Surg 2000;105(7):2331–46.
Triana RJ Jr, Uglesic V, Virag M, Varga SG, Knezevic P, Milenovic A, et al. Microvascular free flap reconstructive options in patients with partial and total maxillectomy defects. Arch Facial Plast Surg 2000;2(2):91–101.
Ali RS, Bluebond-Langner R, Rodriguez ED, Cheng MH. The versatility of the anterolateral thigh flap. Plast Reconstr Surg 2009;124(6 Suppl):e395–407.
Santamaria E, Cordeiro PG. Reconstruction of maxillectomy and midfacial defects with free tissue transfer. J Surg Oncol 2006;94(6):522–31.
Cordeiro PG, Chen CM. A 15-year review of midface reconstruction after total and subtotal maxillectomy: part I. Algorithm and outcomes. Plast Reconstr Surg 2012;129(1):124–36.
Hanasono MM, Silva AK, Yu P, Skoracki RJ. A comprehensive algorithm for oncologic maxillary reconstruction. Plast Reconstr Surg 2013;131(1):47–60.
Pennington DG, Pelly A. The rectus abdominis myocutaneous free flap. Br J Plast Surg 1980;33(2):277–82.
Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg 1984;37(2):149–59.
Koshima I, Yamamoto H, Hosoda M, Moriguchi T, Orita Y, Nagayama H. Free combined composite flaps using the lateral circumflex femoral system for repair of massive defects of the head and neck regions: an introduction to the chimeric flap principle. Plast Reconstr Surg 1993;92(3):411–20.
Koshima I, Fukuda H, Yamamoto H, Moriguchi T, Soeda S, Ohta S. Free anterolateral thigh flaps for reconstruction of head and neck defects. Plast Reconstr Surg 1993;92(3):421–8.
Koshima I, Hosoda M, Moriguchi T, Hamanaka T, Kawata S, Hata T. A combined anterolateral thigh flap, anteromedial thigh flap, and vascularized iliac bone graft for a full-thickness defect of the mental region. Ann Plast Surg 1993;31(2):175–80.
Kimata Y, Uchiyama K, Ebihara S, Yoshizumi T, Asai M, Saikawa M, et al. Versatility of the free anterolateral thigh flap for reconstruction of head and neck defects. Arch Otolaryngol Head Neck Surg 1997;123(12):1325–31.
Lutz BS, Wei FC. Microsurgical workhorse flaps in head and neck reconstruction. Clin Plast Surg 2005;32(3):421–30.
Yu P. Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstruction. Head Neck 2004;26(9):759–69.
Wei FC, Jain V, Celik N, Chen HC, Chuang DC, Lin CH. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg 2002;109(7):2219–26.
Pribaz JJ, Orgill DP, Epstein MD, Sampson CE, Hergrueter CA. Anterolateral thigh free flap. Ann Plast Surg 1995;34(6):585–92.
Huang CH, Chen HC, Huang YL, Mardini S, Feng GM. Comparison of the radial forearm flap and the thinned anterolateral thigh cutaneous flap for reconstruction of tongue defects: an evaluation of donor-site morbidity. Plast Reconstr Surg 2004;114(7):1704–10.
Shieh SJ, Chiu HY, Yu JC, Pan SC, Tsai ST, Shen CL. Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation. Plast Reconstr Surg 2000;105(7):2349–57.
Tamimy MS, Rashid M, Islam MZ, Aman S, Aslam A. A comparison of free transfer of radial forearm and anterolateral thigh flaps for head and neck reconstruction. Eur J Plast Surg 2009;32(2):95–102.
Mureau MA, Posch NA, Meeuwis CA, Hofer SO. Anterolateral thigh flap reconstruction of large external facial skin defects: a follow-up study on functional and aesthetic recipient-and donor-site outcome. Plast Reconstr Surg 2005;115(4):1077–86.
Hanasono MM, Skoracki RJ, Yu P. A prospective study of donor-site morbidity after anterolateral thigh fasciocutaneous and myocutaneous free flap harvest in 220 patients. Plast Reconstr Surg 2010;125(1):209–14.
Mäkitie AA, Beasley NJ, Neligan PC, Lipa J, Gullane PJ, Gilbert RW. Head and neck reconstruction with anterolateral thigh flap. Otolaryngol Head Neck Surg 2003;129(5):547–55.
Huang WC, Chen HC, Jain V, Kilda M, Lin YD, Cheng MH, et al. Reconstruction of through-and-through cheek defects involving the oral commissure, using chimeric flaps from the thigh lateral femoral circumflex system. Plast Reconstr Surg 2002;109(2):433–41.
Demirkan F, Chen HC, Wei FC, Chen HH, Jung SG, Hau SP, et al. The versatile anterolateral thigh flap: a musculocutaneous flap in disguise in head and neck reconstruction. Br J Plast Surg 2000;53(1):30–6.
Lutz BS. Aesthetic and functional advantages of the anterolateral thigh flap in reconstruction of tumor‐related scalp defects. Microsurgery 2002;22(6):258–64.
Nakayama B, Hyodo I, Hasegawa Y, Fujimoto Y, Matsuura H, Yatsuya H, et al. Role of the anterolateral thigh flap in head and neck reconstruction: Advantages of moderate skin and subcutaneous thickness. J Reconstr Microsurg 2002;18(03):141–6.
Posch N, Mureau MA, Flood SJ, Hofer SO. The combined free partial vastus lateralis with anterolateral thigh perforator flap reconstruction of extensive composite defects. Br J Plast Surg 2005;58(8):1095–103.
Nakatsuka T, Harii K, Yamada A, Asato H, Ebihara S. Versatility of a free inferior rectus abdominis flap for head and neck reconstruction: analysis of 200 cases. Plast Reconstr Surg 1994;93(4):762–9.
Zenn MR, Jones GE. Reconstructive surgery: anatomy, technique, and clinical applications. 1st Ed. St. Louis, Mo: Quality Medical Pub; 2012. p.911.
Scheflan M, Dinner MI. The transverse abdominal island flap: part I. Indications, contraindications, results, and complications. Ann Plast Surg 1983;10(1):24–35.
Hartrampf CR Jr. Abdominal wall competence in transverse abdominal island flap operations. Ann Plast Surg 1984;12(2):139–46.
Kroll SS, Baldwin BJ. Head and neck reconstruction with the rectus abdominis free flap. Clin Plast Surg 1994;21(1):97–105.
Slavin SA, Goldwyn RM. The midabdominal rectus abdominis myocutaneous flap: review of 236 flaps. Plast Reconstr Surg 1988;81(2):189–97.
Scheer AS, Novak CB, Neligan PC, Lipa JE. Complications associated with breast reconstruction using a perforator flap compared with a free TRAM flap. Ann Plast Surg 2006;56(4):355–8.
Chana JS, Wei FC. A review of the advantages of the anterolateral thigh flap in head and neck reconstruction. Br J Plast Surg 2004;57(7):603–9.
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