A comparative study between anterolateral thigh flap and radial forearm free flap in head-and-neck reconstruction

Background: Several decades have witnessed the use of free flaps in clinical science. With the advancement and refinement in operative techniques, survival rates of free flaps have increased. There is a need to compare the efficacy and safety of anterolateral thigh (ALT) flap and radial forearm free flap (RFFF) in head-and-neck reconstruction surgeries. Objective: The objective of this study was to compare the ALT flap and RFFF in head-and-neck reconstruction. Materials and Methods: This prospective study was carried out among 25 patients posted for head-and-neck reconstruction in whom either a RFFF or an ALT free flap (ALTF) was performed. Group A had 16 patients reconstructed using the RFFF. Group B had 9 patients reconstructed using ALTF. Results: Majority of the cases were of buccal mucosa cancer. Majority of the RFFFs were performed in buccal mucosa carcinoma patients (43.75%). Majority of the patients with squamous cell carcinoma of the scalp underwent ALTF. RFFFs were most commonly performed in oral cavity (43.75%). Most of the cases of ALTF were performed in the midface and scalp. Mean values of pedicle length, flap length, flap width, and flap thickness were significantly less in the RFFF group compared to the ALTF group. However, the mean time of harvest (min) was significantly less in the RFFF group allowing quick harvest. The difference in donor-site complications in the two groups was not statistically significant except donor-site social stigma. Patients of the RFFF group complained of donor-site social stigma due to ugly looking Split thickness skin graft (STSG) patch at the donor site. The average stay in the hospital after surgery was not found to be statistically significant. Conclusion: ALTF allows a harvest of large tissue for reconstruction as compared to RFFF. Donor-site morbidity is comparable in both the groups except donor-site appearance. RFFFs are harvested easily in less time as compared to Anterolateral thigh free flap (ALTF) due to the complex anatomy of ALTF.