Background
Quality of life and functional improvement have emerged as important goals for oncologic patients. For head and neck cancer patients, free anterolateral thigh (ALT) flaps serve as reliable reconstruction and provide functional restoration. Nevertheless, factors affecting resumption of oral feeding are rarely described. This study aimed to evaluate and compare the functional outcomes of oral feeding for patients with different oncologic defect patterns and reconstructive ALT flap designs.
Methods
We retrospectively reviewed head and neck cancer patients undergoing oncologic ablation and free ALT reconstruction between January 2016 and April 2018 in National Taiwan University Hospital. Patients were categorized into two groups as through-and-through (T&T) and non-through-and-through (non-T&T) according to the defect pattern. We further sub-grouped T&T patients into lip resection (LR)/ lip sparing (LS) according to lip involvement. Reconstructive ALT flaps were of two designs, folded (F-ALT) and chimeric (C-ALT). Outcomes of oral feeding were analyzed using descriptive statistics and differences between groups were compared using Student t test.
Results
We identified 233 patients who received oncologic ablation and free ALT flap reconstruction. There was no significant difference in functional recovery between T&T and non-T&T groups (81.2% vs 73%, p = 0.137). However, among patients who succeeded in resuming oral feeding, LS patients had better functional recovery in terms of early oral feeding within 6 months and nasogastric tube removal compared with LR patients (100% vs 83.3%, p = 0.001). Moreover, F-ALT design resulted in higher success rate in resuming oral feeding compared with C-ALT design (90.5% vs 54.6%, p = 0.032)
Conclusion
Head and neck cancer patients with through-and-through defects were associated with higher rates of secondary flap revision and a trend of delayed oral feeding. In the long term, improved oral feeding outcome with the folded ALT design was observed compared with chimeric ALT design in the specific group with T&T defect.
Key words
Head and neck cancer, free anterolateral thigh flaps, functional outcome, oral feeding