Comparison of the Reconstruction of Large Buccal and Parotid Region Defects in Salvage Surgery Using Anterolateral Thigh Free Flaps and Pectoralis Major Myocutaneous Flaps in Elderly Patients

Abstract Background: With the aging of the population, the percentage of elderly patients with head and neck cancer (HNC) as well as malignant tumors involving the buccal and parotid regions has increased over time. The aim of this study was to compare the outcomes between anterolateral thigh free flaps (ALTFFs) and pectoralis major myocutaneous flaps (PMMFs) for reconstructing large buccal and parotid region defects after salvage surgery in elderly patients.Methods: This study evaluated 48 elderly patients (33 males and 15 females; median age=73.3 years) with large malignant tumors involving the buccal and parotid regions who underwent ALTFF or PMMF reconstruction to repair large buccal and parotid defects following radical resection.Results: Forty-eight patients were included in this study. Twenty-five patients underwent ALTFF reconstruction, while 23 underwent PMMF reconstruction. All elderly patients in this study underwent surgery safely. There was a significant difference between the two groups of defect regions. The operation time was significantly longer in the ALTFF group than in the PMMF group. The rates of recipient site infection and donor site wound dehiscence were greater in the PMMF group than in the ALTFF group. However, there was no significant difference between the ALTFF and PMMF groups in terms of sex, age, ASA score, comorbidity, bleeding amount, blood transfusion, ICU stay, hospital length of stay, total medical cost and systemic medical complications.Conclusions: Age alone was not a risk factor for the surgical treatment of HNC, including tumor ablation and simultaneous flap reconstruction, in elderly patients. Comorbidity status was also not a risk factor for the surgery. Compared to pedicled PMMF reconstruction, an ALTFF is more suitable for reconstructing large buccal and parotid region defects in salvage surgery for elderly patients.