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VRAM Versus ALT Flap Reconstruction for Large Head and Neck Defects: Does Weight Influence Complication Rate?
Courtney B Shires1, Jataiveus Jackson2, Jessica Moskovitz3
1West Cancer Center, 7945 Wolf River Blvd, Germantown, TN 71115, USA.
Journal of Personalized Medicine
|July 27, 2024
Summary
Obese head and neck cancer patients had fewer complications with anterolateral thigh (ALT) flaps than vertical rectus femoris myocutaneous (VRAM) flaps. Normal and underweight patients experienced fewer complications with VRAM flaps compared to ALT flaps.
Area of Science:
- Surgical Oncology
- Reconstructive Surgery
- Plastic Surgery
Background:
- Obesity is a significant risk factor for various cancers, but paradoxically, higher BMIs may improve survival in head and neck squamous cell carcinoma (HNSCC).
- The impact of obesity on surgical outcomes in head and neck cancer patients, particularly regarding flap reconstruction, requires further investigation.
- Selecting the optimal flap for head and neck reconstruction is complex, influenced by flap characteristics and patient-specific factors like BMI and prior radiation.
Purpose of the Study:
- To compare the surgical outcomes of vertical rectus femoris myocutaneous (VRAM) and anterolateral thigh (ALT) flaps in overweight and obese patients with head and neck cancer.
- To evaluate flap reconstruction outcomes in normal and underweight patients with head and neck cancer for comparison.
- To assess the influence of patient BMI on complication rates following large-defect head and neck reconstruction.
Main Methods:
- Retrospective chart review of patients undergoing VRAM or ALT flap reconstruction for large head and neck defects over 12 months.
- Categorization of patients into underweight, normal weight, overweight, and obese groups based on BMI.
- Analysis of complication rates associated with ALT and VRAM flaps across different BMI categories.
Main Results:
- For ALT flaps, complication rates were 80% (underweight), 57% (normal), 50% (overweight), and 33% (obese).
- For VRAM flaps, complication rates were 40% (underweight), 83% (overweight), and 50% (obese).
- Obese patients showed lower complication rates with ALT flaps (33%) compared to VRAM flaps (50%).
Conclusions:
- In this small sample, anterolateral thigh (ALT) flaps demonstrated a lower complication rate in obese head and neck cancer patients compared to vertical rectus femoris myocutaneous (VRAM) flaps.
- Vertical rectus femoris myocutaneous (VRAM) flaps were associated with fewer complications in normal and underweight head and neck cancer patients than ALT flaps.
- Flap selection for head and neck cancer reconstruction should consider patient BMI to optimize surgical outcomes and minimize complications.
