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Suprafascial anterolateral thigh flap harvest has low donor-site morbidity

Suprafascial anterolateral thigh flap harvest is a safe alternative for head and neck reconstruction with a low rate of donor-site morbidity, according to study results published in Plastic and Reconstructive Surgery.

The researchers examined the effect of preserving the deep fascia and the medial branch of the lateral femoral cutaneous nerve on donor-site morbidity. Between January 2013 and December 2013, a total of 61 patients were divided into two flap-type groups for head and neck reconstruction: suprafascial anterolateral thigh flap (n = 30) and subfascial anterolateral thigh flap (n = 31).

Evaluation consisted of three factors: motor ability, sensation, and satisfaction. Neither flap success rate nor rate of flap complications was significantly different between the two groups.

Regarding motor ability, two patients in the suprafascial group reported donor thigh muscle weakness, though no patients reported complication with range of motion of the knee joint. Three patients in the subfascial group reported donor weakness and one patient reported limited knee joint motion.

Seven patients in the subfascial group reported abnormal sensation, including: dysesthesia (n = 2), paresthesia (n = 1), numbness (n = 3), and itching (n = 5). Twenty-six patients in the subfascial group reported the following sensations: dysesthesia (n = 10), paresthesia (n = 9), numbness (n = 22), itching (n = 7), and cold intolerance (n = 1).

Patients self-evaluated postoperative outcomes on a functional and cosmetic scale. In the suprafascial group, 66.6% of patients rated the outcomes as excellent, 23.3% as good, 6.7% as acceptable, and 3.3% as poor. In the subfascial group, 25.8% reported excellent results, 61.3% reported good results, 6.5% reported reported acceptable results and 6.5% reported poor results. The satisfaction rates were higher in the suprafascial group than the subfascial group (P = .03).

Long-term follow up found that the majority of subjective complaints were related to abnormal sensations, with higher numbers shown in the subfascial group. All patients, however, returned to preoperative level of mobility at 6 months follow-up.

“If the surgeon is skilled and confident, suprafascial dissection has been proven to be as safe as subfascial dissection in terms of recipient-site complications and produces less donor-site morbidity, a thinner flap, and better patient satisfaction,” the researchers wrote. – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.