Radial Forearm versus Anterolateral Thigh Free Flaps for Laryngopharyngectomy Defects: Prospective, Randomized Trial

Objective: To investigate the use of anterolateral thigh flaps versus radial forearm free flaps for the reconstruction of laryngopharyngectomy defects in a prospective, randomized study. Methods: Nineteen patients who were to undergo laryngopharyngectomy were randomized into either anterolateral thigh or radial forearm groups. The primary outcome measure was complication rate (eg, flap failure, fistula formation, pharyngeal stenosis). Secondary outcome measures included donor-site morbidity (limb function, cosmesis, pain). Results: There was a significant (p = 5.04) increase in reconstructive complications in the anterolateral thigh group, including esophageal stenosis and pharyngeal fistulae. There was no significant difference in donor-site complications. Conclusion: There is an increased free flap complication rate without decreased flap donor-site morbidity when using the anterolateral thigh flap to reconstruct laryngopharyngectomy defects. As such, we recommend the radial forearm free flap as the preferred flap for reconstruction of laryngopharyngectomy defects.