Comparative Outcomes of Super Thin Anterolateral Thigh Flaps Versus Radial Forearm Free Flaps in Head and Neck Reconstruction

BACKGROUND: The anterolateral thigh (ALT) flap is a versatile reconstructive option for head and neck defects but may be excessively bulky in contour-sensitive regions. Super thin ALT flaps (≤ 10 mm) have been introduced to improve pliability and contour; however, their comparative clinical advantages over established fasciocutaneous flaps remain unclear. This study aimed to evaluate the clinical outcomes of super thin ALT flaps and to compare them with radial forearm free flaps (RFFF) in head and neck reconstruction. METHODS: A retrospective study was conducted on patients who underwent head and neck reconstruction with super thin ALT flaps between 2021 and 2023 at a single tertiary center. A comparative cohort of patients reconstructed with RFFF during the same period was also included. Super thin ALT flaps were elevated within the superficial fascial layer with a target thickness of ≤ 10 mm. Outcomes assessed included complication rates, fistula formation, reoperation, flap failure, and operative time. Postoperative drain amylase levels were analyzed as a surrogate marker for salivary leakage. RESULTS: A total of 28 patients in the super thin ALT group and 44 in the RFFF group were included in the analysis. All ALT flaps survived without partial necrosis. There were no statistically significant differences between the groups in total complication rate (7.1% vs. 11.3%, p = 0.692), fistula formation (3.5% vs. 6.8%, p = 1.000), reoperation (7.1% vs. 11.3%, p = 0.692), or operative time (145 ± 34 min vs. 159 ± 42 min, p = 0.125). No flap failure occurred in the super thin ALT group, whereas three cases (6.8%) were observed in the RFFF group. The super thin ALT group demonstrated lower postoperative amylase levels, although the difference was not statistically significant. CONCLUSION: Super thin ALT flaps provide clinical outcomes comparable to those of RFFF while offering enhanced pliability and improved conformity to complex defects. These characteristics make them a reliable and versatile alternative for head and neck reconstruction, particularly in contour-sensitive regions.