Factors Affecting Volume Change of Anterolateral Thigh Flap in Head and Neck Defect Reconstruction

Abstract

The anterolateral thigh flap (ALTF) volume will decrease over time after surgery. We measured and identified the risk factors for postoperative volume changes in the ALTF. We designed and performed a retrospective cohort study of patients who had undergone reconstruction of oral and maxillofacial defects using ALTFs at the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from June 2012 to December 2018. We measured the volume of the ALTFs at 1, 3, 6, 12, and 24months postoperatively; the flap volume at 1month postoperatively was taken as the baseline. The primary outcome variables were the residual ALTF rates at 3, 6, 12, and 24months postoperatively, defined as the ratio between the present volume at each month and at baseline. The primary predictor variables were the clinical variables that might be associated with ALTF volume loss. Descriptive and bivariate statistics were computed, and the P value for statistical significance was set at≤.05. The sample included 70 subjects with a mean age of 53.8years (46 men and 24 women). The postoperative residual rates at 3, 6, 12, and 24months were 72.3, 69.0, 67.9, and 68.7%, respectively, of the baseline volume. The use of postoperative radiotherapy (P<.01) and low body mass index (BMI; P=.006) were significantly associated with postoperative ALTF volume loss. The results of the present study suggest that ALTF volume shrinkage mainly occurs within 6months postoperatively and that postoperative radiotherapy and a low BMI are risk factors for volume loss. Overcorrection should be performed to account for the shrinkage of ALTFs, and postoperative nutrition management is important to avoid ALTF volume loss.