Comparing outcomes of radial forearm free flaps and anterolateral thigh free flaps in oral cavity reconstruction: A systematic review and meta-analysis

Abstract

Objectives: To compare surgical morbidity, functional and aesthetic restoration, and health-related quality of life among patients receiving anterolateral thigh (ALT) or radial forearm (RFF) free flaps for intra-oral reconstruction.

Materials and methods: PubMed, Medline, EMBASE, CINAHL, and CDSR databases were searched from 2000 to 2022. Primary outcomes included flap survival, recipient site complications, donor site morbidity, recovery of oral function, and quality of life among patients after oncologic resection and reconstruction of oral cavity defects with ALT or RFF.

Results: A total of 23 criteria-meeting studies with 685 ALT and 723 RFF patients were included. There were no differences between the two groups in flap survival or the likelihood of flap-related complications. There was a significantly lower likelihood of donor site morbidity among ALT patients, specifically hypertrophic scarring (OR 0.24, 95 % CI: 0.06-0.96), tendon exposure (OR 0.13, 95 % CI: 0.03-0.60), paresthesia (OR: 0.06, 95 % CI: 0.01-0.25), movement impairment (OR: 0.12, 95 % CI: 0.04-0.38), and social stigma (OR: 0.10, 95 % CI: 0.03-0.28). ALT patients were significantly more likely to be satisfied with the donor site appearance (OR: 8.75, 95 % CI: 1.11-68.73). There were no significant differences in recovery of regular diet and speech or quality of life.

Conclusion: The findings suggest that the ALT achieves equivalent flap survival rates and oral function with less donor site morbidity compared to the RFF for intra-oral reconstruction. Nonetheless, choice of free flap should incorporate surgeon- and patient-specific factors that may not be reflected in the studies included in this meta-analysis.

Keywords: Anterolateral Thigh Free Flap; Free Flap; Head and Neck Cancer; Oral Cancer; Radial Forearm Free Flap; Reconstruction.