Free flap reconstruction is the gold standard in tongue reconstruction, aiming to restore function such as swallowing, cosmesis and speech. The anterolateral thigh cutaneous flap and the radial forearm free flap are among the most popular free flaps used for tongue reconstruction. The authors aimed to assess the outcome between the two flaps used by performing a meta-analysis of the literature published before January 2015. Twelve clinical papers were included with a total of 366 patients: 198 patients had radial forearm flaps (54%) and 168 anterolateral thigh flaps (46%). The authors found no significant difference between the flaps in terms of flap survival, complications and vascular crises. There was also no significant difference between the flaps in terms of satisfaction with tongue reconstructive appearance, swallowing capacity and speech intelligibility.
However, on assessment of patient satisfaction with the donor site such as the appearance and postoperative numbness, the authors found that patients who had the radial forearm flap were more adversely affected.
The authors concluded that the anterolateral thigh flap is superior as it not only gives equal function and reliability as the radial forearm flap but also with a reduced donor site morbidity without sacrificing a major source of vascularisation to the hand and an unattractive scar on the forearm. Most of the papers studied by the authors were from Asia however and the size of the thigh and forearm may be different in different populations and hence complications from donor sites may be different.