Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, Taiwan.
Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, Taiwan.
Microsurgery. 2020 Sep;40(6):679-685. doi: 10.1002/micr.30635. Epub 2020 Aug 17.
The anterolateral thigh (ALT) flap is a workhorse flap in head and neck cancer reconstruction. The anteromedial thigh (AMT) flap was developed as a rescue or alternative flap whenever the ALT flap is not available; however, the harvest of AMT flap seems to be more challenging in the sense that perforators have multiple variations. This study was designed to compare the outcome of the AMT and ALT flaps in head and neck cancer reconstruction.
A total of 1,547 ALT and 57 AMT flaps were used for head and neck cancer reconstruction between March 1, 2008 and February 28, 2017. Differences in patient and operative characteristics were compared between the patients undergoing AMT and ALT flap reconstruction. The primary outcome of the free flap was its survival or failure, while the second outcome was the associated complications.
Compared to those who had ALT flap reconstruction, the patients who underwent AMT flap reconstruction had a higher rate of conditions that required reconstruction after previous cancer ablation and recurrence but a lower rate of primary cancer and deeply located cancer. Analysis of the 40 well-balanced pairs of propensity-score-matched patient cohorts revealed that the AMT flaps were associated with a significantly higher failure rate than the ALT flaps (15.0 vs. 0.0%, respectively; p = .026).
This study revealed that AMT flaps were associated with a significantly higher failure rate than ALT flaps in head and neck cancer reconstruction in the cohort of total patients and the propensity-score-matched cohorts.
股前外侧皮瓣（ALT）是头颈部癌症重建中的主力皮瓣。股前内侧皮瓣（AMT）是作为 ALT 皮瓣不可用时的救援或替代皮瓣而开发的；然而，AMT 皮瓣的采集似乎更具挑战性，因为穿支有多种变化。本研究旨在比较 AMT 和 ALT 皮瓣在头颈部癌症重建中的结果。
2008 年 3 月 1 日至 2017 年 2 月 28 日，共使用 1547 个 ALT 和 57 个 AMT 皮瓣进行头颈部癌症重建。比较接受 AMT 和 ALT 皮瓣重建的患者的患者和手术特征差异。游离皮瓣的主要结果是其存活或失败，其次是相关并发症。
与接受 ALT 皮瓣重建的患者相比，接受 AMT 皮瓣重建的患者先前癌症消融和复发后需要重建的情况发生率更高，但原发性癌症和深部癌症的发生率较低。对 40 对平衡良好的倾向评分匹配患者队列进行分析显示，AMT 皮瓣的失败率明显高于 ALT 皮瓣（分别为 15.0%和 0.0%；p =.026）。
本研究表明，在总患者队列和倾向评分匹配队列中，AMT 皮瓣在头颈部癌症重建中的失败率明显高于 ALT 皮瓣。
