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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2018

01-03-2018 | Reconstructive Oncology

Anterolateral Thigh Flap Combined with Reconstruction Plate Versus Double Free Flaps for Composite Mandibular Reconstruction: A Propensity Score-Matched Study

Authors: Anaeze C. Offodile II, MD, MPH, Jennifer An-Jou Lin, MD, Kai-Ping Chang, MD, PhD, Mohamed Abdelrahman, MD, Hao-Wei Kou, MD, Charles Yuen Yung Loh, MBBS, MSc, MRCS, Mario A. Aycart, MD, Huang-Kai Kao, MD, FACS

Published in: Annals of Surgical Oncology | Issue 3/2018

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Abstract

Objective

This study was designed to examine the comparative effectiveness of oromandibular defect reconstruction via anterolateral thigh flap and bridging plate (ALT only) versus simultaneous soft tissue and vascularized bone flap (DFF), with regards to long-term plate exposure and complications.

Methods

A propensity score-matched analysis of patients with an oncologic head and neck defect who underwent microvascular reconstruction was performed. Two surgical groups, i.e., ALT only and DFF, were created. Incidence and subsequent management strategies for postoperative plate exposure were evaluated along with complications, overall survival, and postoperative quality of life (QoL).

Results

Sixty-two patients were 1:1 propensity matched (31 per group). The DFF group had a significantly larger soft tissue and bone defect than the single-flap group. The 5-year probability of not having a plate exposure was 45.5 and 47.4% for the double-flaps and single-flap groups, respectively (p = 0.186). The ALT-only group had a significantly higher rate of wound infections (38.7% vs. 12.9%, p = 0.02). The incidence of flap loss, reexploration, inpatient mortality, plate fracture, medical complications, and overall survival were not significantly different. Although mean score for pain was significantly worse in the ALT-only group (75.2 vs. 88.5, p < 0.001), the remainder of our QoL assessments (cosmesis, swallow, employment, and speech) were comparable.

Conclusions

The utilization of an ALT with plate strategy is associated with competitive rates of plate exposure and overall survival relative to DFF but higher wound infections and long-term pain. These results have considerable salience for patient-counseling regarding expectations for functional and clinical outcomes.
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Metadata
Title
Anterolateral Thigh Flap Combined with Reconstruction Plate Versus Double Free Flaps for Composite Mandibular Reconstruction: A Propensity Score-Matched Study
Authors
Anaeze C. Offodile II, MD, MPH
Jennifer An-Jou Lin, MD
Kai-Ping Chang, MD, PhD
Mohamed Abdelrahman, MD
Hao-Wei Kou, MD
Charles Yuen Yung Loh, MBBS, MSc, MRCS
Mario A. Aycart, MD
Huang-Kai Kao, MD, FACS
Publication date
01-03-2018
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 3/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-017-6309-1

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