Comparison of functional outcomes of radial forearm and anterolateral thigh free flaps after hemiglossectomy in patients with tongue cancer: a systematic review and meta-analysis

Abstract

Introduction:  One of the surgical challenges of tongue cancer is its functional reconstruction. The radial forearm free flap (RFFF) is usually used in minor resections such as partial glossectomies, and the anterolateral thigh flap (ALTFF) in subtotal and total glossectomies. In hemiglossectomy, there is controversy because there is no rigorous review that considers functional results.

Objectives: To compare functional outcomes among patients receiving RFFF or ALTFF for tongue reconstruction after hemiglossectomies.

Materials and methods: A comprehensive search was conducted in PubMed, EMBASE, and CENTRAL databases from inception until August 2023. This rigorous approach ensured that all relevant studies were included. Primary outcomes included speech and swallowing after hemiglossectomies reconstruction with RFFF or ALTFF, providing a comprehensive overview of the functional outcomes.

Results: Our analysis included six studies meeting the criteria and involved 148 RFFF and 94 ALTFF patients. The key finding was the significantly better speech results in the RFFF group (SMD: 0.30; 95% CI [0.03, 0.56], p-value = 0.0301). However, there were no significant differences in swallowing outcomes, which warrants further investigation.

Conclusion: Our findings indicate that the RFFF is associated with better speech results than the ALTF for hemiglossectomies reconstruction. However, it's important to note that the RFFF also carries a higher risk of donor site complications. Therefore, when choosing the flap for reconstruction, the preferences of the surgeon and the patient should be considered, and the potential complications should be carefully considered.