Super-Thin ALT Free Flap Technique Feasible for Select Patients Receiving Oral Cavity and Oropharyngeal Reconstruction

CLINICAL QUESTION

What is the feasibility of employing super-thin anterolateral thigh (ALT) free flaps for reconstruction of complex oral cavity and oropharyngeal defects?

BOTTOM LINE

The super-thin ALT free flap harvest technique represents a feasible option for oral cavity and oropharyngeal reconstruction in select patients and does not require additional surgical training, invasive testing, or technology.

BACKGROUND: Radial forearm free flaps (RFFFs) and anterolateral thigh free flaps (ALTFFs) have become soft tissue reconstruction workhorses. Although ALTFFs have a lower donor site morbidity than RFFFs, unwanted tissue thickness and bulk limit their utility in oral cavity reconstruction. Moreover, injury to the flap’s microcirculation during flap thinning remains a concern.

STUDY DESIGN: Retrospective review

SETTING: Department of Otolaryngology–Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, D.C.

SYNOPSIS: Researchers performed a chart review for patients receiving soft tissue microvascular reconstruction at a tertiary referral center from 2020 to 2023. Sixteen super-thin anterolateral thigh free flaps (ST-ALTFF) were performed in 15 patients (94% male; mean age 61.5 years) for reconstruction of oral cavity defects. The defects included seven oral tongue, three floor of mouth, three buccal, two oropharynx, and one lower lip. The average operative time was 509 minutes, and the average length of hospitalization was nine days. Tumor T staging was T2 in six cases (37.5%), T3 in five cases (31%), and T4 in four cases (25%). Approximately 94% of cases included neck dissection at the time of surgery. The chart review showed ST-ALTFF was successfully used in all but one patient. Of the 15 successful cases, two flap complications were experienced, neither requiring operating room takeback within 30 days. Two patients required gastrostomy placement prior to discharge for dysphagia. Authors note that ST-ALTFF harvest requires a straightforward alteration to the traditional ALTFF harvest technique, but that ST-ALTFFs are dependent on the perforator anatomy, which can be variable or absent. Study limitations included its small size and retrospective nature.

CITATION: Chisolm P, et al. Feasibility of super-thin anterolateral thigh free flap for oral and pharyngeal reconstruction. Laryngoscope. 2025;135:1386-1390. https://doi.org/10.1002/lary.31836.

COMMENT: This article describes a novel “super thin” anterior lateral thigh flap technique for oral cavity reconstruction. This flap is well known for larger defect reconstruction, and the authors highlight the utility of this smaller and thinner flap for defect reconstruction when this type of bulk is not needed but mucosal reconstruction is required. —Jonathan Bock, MD