Study Of 60 Free Anterolateral Myocutaneous Flaps Donor-site Complications And Functional Assessment

ObjectiveTo investigate the donor-site complications of the free anterolateral myocutaneous flap which used to repair the soft tissue defects caused by the oral carcinoma operation. And make an assessment for the functional recovery of the donor-site. Provide clinical guidance on choosing a better method to make free anterolateral thigh flap in order to reduce the complications in donor-site.Methods61 patients from February 1st,2011 to May 1st,2011 who have reexamination in the second XiangYa Hospital,Central South University were selected. They all have suffered the resection of oral and maxillofacial malignant and inⅠphase reconstruction with free anterolateral myocutaneous flap. Consult their medical records, patients with preoperative donor-site morbidity from cerebral dysfunction or osteoarthritis of the lower extremities were excluded. So, we actually selected 60 patients. With the help of a same Rehabilitation practitioner who have rich clinical experience, several variables were assessed in the intraoperative and postoperative period, and a questionnaire was given to patients(Appendix 1). The data were analysed by descriptive analysis and T test using SPSS 17.0 software package.ResultsAll patients finished the evaluation table and questionnaire. All patients were followed up for 32-1287days (mean:319 days). There were 52 males and 8 females aged 25-68 years old (mean:51.75±10.29 years old). The free flaps ranged in size from 2cmx4cm-6cm×22cm, and muscle flap were 2cmx2cm-6cmx7cm. The survival rate was 98.3% with only 1 total flap loss due to not reversible venous thrombosis. Primary skin closure on donor-site was performed in 58 patients. Skin grafting was performed in 2 patients. Early postoperative donor-site complications included:infection (n=6), wound dehiscence (n=1), and hematoma (n=1), no skin graft necrosis, no muscle necrosis. The long-term complications included muscle weakness (n=7), unsatisfactory scar appearance (n=3), sensory disturbance (n=50), in anterolateral thigh upper region sensory hypoesthesia (n=10), in anterolateral thigh middle region sensory hypoesthesia (n=39) and sensory deprivation (n=1), in anterolateral thigh lower region sensory hypoesthesia (n=40) and sensory deprivation (n=5). Two patients had intolerance to cold. No muscle herniation, no limitation of range of motion of hip and knee.Conclusions1. Sensory disturbance occurred in anterolateral thigh region of the donor-site especially concentrated in middle and lower area after free anterolateral myocutaneous flaps were made. It was related to damage of lateral femoral cutaneous nerve.2.The bigger size and higher position we make free anterolateral myocutaneous flap, the more risk we will have sensory disturbance on donor-site.3.Muscle weakness were not significantly related to sacrifice of the size of vastus lateralis muscle.4.Few patients were bothered by the appearance of the scar because of the hidden donor-site of the free anterolateral thigh flap.