Comparing Functional Outcomes Following TORS With Free Flap Reconstruction Using a Radial Forearm vs. Anterolateral...

Area of Science:

• Head and Neck Surgery
• Reconstructive Surgery
• Oncology

Background:

• Free flap reconstruction (FFR) is crucial after transoral robotic surgery (TORS) for oropharyngeal cancer.
• Radial forearm free flaps (RFFFs) are commonly used, but anterolateral thigh flaps (ALTFs) are an alternative.
• Comparing functional recovery patterns between RFFFs and ALTFs is important for optimizing patient outcomes.

Purpose of the Study:

• To compare functional oral intake recovery between RFFFs and ALTFs following TORS.
• To evaluate the suitability of ALTFs for larger defects in TORS reconstruction.
• To assess complication rates and PEG tube dependency between flap types.

Main Methods:

• Retrospective cohort study of 105 patients undergoing TORS with FFR (2010-2023).
• Propensity score matching (1:4 ALTF:RFFF) was employed for cohort comparison.
• Functional Oral Intake Scale (FOIS) was used to assess oral intake function.

Main Results:

• ALTF patients demonstrated lower FOIS scores at 6 months and 1 year post-surgery.
• Higher rates of percutaneous endoscopic gastrostomy (PEG) tube use were observed in the ALTF group.
• ALTFs were utilized for significantly larger defect sizes compared to RFFFs, with similar donor site morbidity and complication rates.

Conclusions:

• ALTFs are a viable option for larger defects in TORS reconstruction.
• Patients receiving ALTFs experience a slower initial functional recovery and higher PEG tube dependency compared to RFFFs.
• No significant differences in postoperative complications or donor site morbidity were found between the two flap types.