الفهرس 
AcknowledgmentOnly 14 pages are availabe for public view
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Abstract
Summary and Conclusion: Head and neck defects can result from multiple causes; trauma, tumour resection, developmental disease…..etc. These defects can be soft tissue defects, bone defects or both. This is a region characterized by having a complex construction as regards both the anatomy and function.
Different modalities for reconstruction are present, grading from primary closure through grafting, local, regional and pedicled flaps to free tissue transfer.
The RFFF and free ALT flaps are currently considered the workhorse flaps for reconstruction of different body parts and particularly the head and neck. That was due to their fulfillment to most of the criteria of the ideal flap regarding the availability of plenty of tissue with multiple natures, ease of harvesting and relatively constant anatomy and similarity of color and texture to the target site.
The literature didn’t precisely answer the question about which of these two flaps is better. However, many stated on the similarity of the reconstructive results of both flaps and preferring the ALT for the better donor site outcome.
This study aims for comparison between Radial forearm free flap and anterolateral thigh flap for head and neck reconstruction in terms of flap versatility operative time, hospitalization time, early and late complications, donor site morbidity and cosmetic outcome in patients presented at Plastic Surgery department, Sohag University Hospitals from January 2019 to January 2021.
In the current study 18 patients with head and neck defects of different causes divided into 2 groups: group A included 10 patients for whom a RFFF was done for reconstruction and group B that included 8 patients for whom the free ALT flap was done.
The commonest cause was excision of malignant tumors (10 cases) followed by traumatic defects (7 cases) and 1 case of Romberg’s disease.
The overall success rate was 72.2% (11 fully survived flaps and 1 case of peripheral necrosis) and 27.8% of the flaps were lost (5 cases).
As regards the age incidence, it was noticed that age ranged from 18 to 85 years old in group A (average 59.1 ± 1805) while ages in group B were younger ranging from 3 to 63 years old (average 21.5 ± 20.9) which is considered highly significant.
Defect size was not significantly different between the two groups, as it ranged from 15 to 96 cm2 in group A with an average of 47.5 ± 28.6 cm2 and for group B it ranged from 24 to 130 cm2 with an average of 59 ± 37.2 cm2.
The distribution of the defect site according to group was as follows: the forehead defects in 7 cases: 2 in group A and 5 in group B, the lip and oral commissure in 5 cases all in group A, the cheek in 4 cases: 2 in each group, 1 case of orbital defect in group A and 1 case of temporal defect in group B.
The overall complication rate was 55.6% (10 cases) distributed by group as follows: 70% (7 cases) in group A: 2 cases of total flap loss, 1 case of peripheral congestion and ischemia, 2 cases of moderate oedema and surgical site infection and 2 cases of hematoma which was evacuated, and the flap was salvaged. For group B the complication rate was 37.5% (3 cases) all were in the form of venous congestion and total flap loss.
The donor site in group A was closed by a split thickness skin graft (STSG) in all cases with full take and no reported complications, while in group B only 2 cases (25%) needed the skin graft closure that was fully taken with no reported complications and 6 cases (75%) healed by primary intention after direct closure.
The rate of secondary procedure was comparable between both group (60% for group A and 50% in group B) and it was for debridement of an ischemic tissue followed by further reconstruction by local tissue (3 cases for each group) or for debulking and refinement of the flap that was performed 6 months after the prior surgery (3 cases for group A and 2 cases in group B).
The follow up period ranged from 6 months to 1 year for both groups.
Conclusion:
Free flaps are coming in advance for choices in reconstruction of head and neck defects of various reasons. Most of these defects are of large sizes and are due to trauma or more often a wide excision of a malignant tumor, which makes it hard to reconstruct using local tissues with minimal affection of cosmesis.
The radial forearm free flap (RFFF) was considered the perfect choice for free tissue transfer to the head and neck until the introduction of the free anterolateral thigh (ALT) flap as an alternative. Both flaps have their advantages over each other, but the most evident is the advantage of the ALT over the RFFF as regards the donor site and the relatively consistent anatomy.
Thus, regarding this study, it is recommended that both flaps are competent in the context of head and neck reconstruction, with the preference of the RFFF in the elderly and the ALT in the younger age group with care of venous drainage either by double vein drainage or connecting the flap vein to a large caliber vein like the external jagular for sufficient drainage.