Anterolateral Thigh Free Flap in Head and Neck Reconstruction of the Very Elderly

Although free flap reconstruction in the elderly population is safe, head and neck cancer patients often suffer from concomitant disease that limits donor-site options. The anterolateral thigh (ALT) free flap is reliable and versatile and has minimal donor-site morbidity. This study reviewed the authors' institutional experience in use of the ALT free flap for head and neck reconstruction in an elderly population.

A retrospective chart review was performed between 2000 and 2004. Patients were selected for inclusion if they met the following criteria: age greater than 75 years, resectable head and neck cancer, and reconstruction with ALT free tissue transfer.

Seven patients, with a mean age of 81 years and ASA class 3, met the inclusion criteria. The majority of cancers (5) were squamous cell and all involved the head and neck region. The ALT flap was harvested as a perforator flap with a mean size of 185 cm2. Mean operative time was 8 hr. Length of hospital stay was 10 days. Postoperative complications included delayed wound healing and subcutaneous abscess formation managed on an outpatient basis. Follow-up revealed no major donor-site complications. One patient had early disease recurrence and one patient died at 9 months post-surgery due to sepsis of unclear etiology. Of patients receiving postoperative radiation therapy, no flap-related complications were reported.

The very elderly patient population with extensive head and neck malignancy represents a unique challenge to the reconstructive surgeon. Peripheral vascular disease and history of previous surgery may limit reconstructive options. The anterolateral thigh flap facilitates a two-team approach and, with primary closure of the donor site and subsequent minimal complications, may represent the ideal flap to use in this special patient population.