Plastic Surgery Research Council

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Indications and Outcomes of Single-Pedicle versus Two-Pedicle Thigh Free Flaps in Head and Neck Reconstruction
Becky B. Trinh, MD, Ivan E. Rodriguez, MD, Frederic W.B. Deleyiannis, MD, MPhil, MPH, FACS.
University of Colorado, Aurora, CO, USA.

Purpose: The anterolateral thigh (ALT) free flap is one of the most commonly used flaps for head and neck reconstruction. Given that perforators of an ALT flap routinely arise sequentially from the descending branch of the lateral circumflex artery as it descends down the thigh, a long ALT flap can be more reliably harvested than a wide ALT flap. The purpose of this study is to demonstrate indications and outcomes for single-pedicle ALT free flaps compared to double-pedicle ALT flaps as well as multiple simultaneous thigh (MST) flaps.
Methods: Our series of 81 consecutive patients undergoing head and neck reconstruction with an ALT flap was retrospectively reviewed. Patients with a composite mandibular defect who underwent reconstruction with both a fibular free flap and an ALT free flap were excluded. Receiver operating characteristics curve analysis was performed to determine our cut-off values for width and length of single-pedicle versus double-pedicle ALT flaps.
Results: Fifty-seven and 18 patients were reconstructed with an ALT flap with one or two pedicles, respectively. Six patients underwent MST flaps. Defect size (width ≥12 cm, length ≥17 cm) for cutaneous defects (p<0.05), the presence of divergent mucosal defects, and through-and-through oral cavity or pharyngeal defects were associated with the use of two pedicles. There was one flap failure of a single-pedicle ALT flap. While operative time was increased for the groups of double-pedicle ALT flaps and MST flaps, there were no flap complications including partial flap loss, venous congestion, or wound healing issues from poor flap perfusion.
Conclusion: Harvesting an ALT flap with two pedicles has the potential to reduce flap complications and should be considered for divergent and extremely wide (>12 cm) or extremely long (>17 cm) defects. Our proposed algorithms will help guide flap choice when designing an ALT free flap for a cutaneous and/or mucosal defect of the head and neck.


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