The application of fibular free flap with flexor hallucis longus in maxilla or mandible extensive defect: a comparison study with conventional flap.

BACKGROUND: The repair and reconstruction of maxillary and mandibular extensive defects have put huge challenges to surgeons. The fibular free flap (FFF) is one of the standard treatment choices for reconstruction. The conventional FFF has deficiencies, such as forming poor oral mucosa, limited flap tissue, and perforator vessel variation. To improve the use of FFF, we add the flexor hallucis longus (FHL) in the flap (FHL-FFF). In this paper, we described the advantage and indication of FHL-FFF and conducted a retrospective study to compare FHL-FFF and FFF without FHL. METHODS: Fifty-four patients who underwent FFF were enrolled and divided into two groups: nFHL group (using FFF without FHL, 38 patients) and FHL group (using FHL-FFF, 16 patients). The perioperative clinical data of patients was collected and analyzed. RESULTS: The flaps all survived in two groups. We mainly used FHL to fill dead space, and the donor-site morbidity was slight. In FHL group, flap harvesting time was shorter (118.63 ± 11.76 vs 125.74 ± 11.33 min, P = 0.042), the size of flap's skin paddle was smaller (16.5 (0-96) vs 21.0(10-104) cm2, P = 0.027) than nFHL group. There were no significant differences (P > 0.05) in hospital days, hospitalization expense, rate of perioperative complications, etc. between the two groups. Compared with FFF without FHL, FHL-FFF will neither affect the use of flap nor bring more problems. CONCLUSION: The FHL-FFF simplifies the flap harvesting operation. The FHL can form good mucosa and make FFF rely less on skin paddle. It can be used for adding flap tissue and dealing with perforator vessel variation in reconstruction of maxillary and mandibular extensive defects.

Transverse cervical vessels as recipient vessels in oral and maxillofacial microsurgical reconstruction after former operations with or without radiotherapy.

BACKGROUND: The purpose of this study was to investigate the reliability and outcome of using the transverse cervical vessel (TCV) as a recipient vessel for microvascular reconstruction in patients whose vessels in the neck region are unavailable because of previous surgery or radiotherapy. METHODS: Between January 2012 and August 2014, secondary head and neck reconstruction was performed using the TCV as a recipient vessel in eight patients who had undergone previous neck dissection and radiation therapy (n = 5). Five patients had a recurrent carcinoma, one had undergone an operation for scar release and two had been treated surgically for a second primary cancer. The anterolateral thigh flap (ALT), anteromedial thigh flap (AMT), and fibular flap were used for the reconstruction. Clinical data were recorded for each patient. RESULTS: All of the ipsilateral transverse cervical arteries were found to be free of disease. The second free flap was revascularized using the TCVs (n = 6) or the external (n = 1) or internal (n = 1) jugular vein. The free flaps used for the reconstruction included the ALT flap (n = 6), AMT flap (n = 2), and fibular flap (n = 1). All of the flaps survived without vascular events, and the patients healed without major complications. The mean follow-up time was 11 months. One patient died of distant metastases during follow-up. CONCLUSIONS: In patients who have previously undergone neck surgery with or without radiotherapy, the TCVs are reliable and easily accessible recipient vessels for microsurgical reconstruction in the oral and maxillofacial region. If the transverse cervical vein is unavailable, the internal or external jugular vein should be dissected carefully to serve as an alternative for microvascular anastomoses.

Free flap reconstruction versus non-free flap reconstruction in treating elderly patients with advanced oral cancer.

PURPOSE: Our goal was to evaluate whether elderly patients can benefit from free flaps. MATERIALS AND METHODS: The clinical information from the included patients was reviewed, and these patients were asked to complete the University of Washington Quality of Life, version 4, questionnaire. Comparisons of the different scales between the 2 groups were performed. RESULTS: The difference in the mouth-opening width before and after surgery did not differ significantly (P = .621) in the patients with and without free flap reconstruction. However, free flap placement tended to preserve the original mouth-opening width. No significant differences were found in recurrence-free survival or disease-specific survival between the 2 groups. The mean quality of life score of the 2 groups was 77.5 ± 10.4 and 72.1 ± 10.8. Significant differences were found in the chewing domain scores between the 2 groups (P = .039). Patients with free flap reconstruction tended to score better in the appearance and taste domains (P = .073 and P = .053, respectively); however, they required longer operative times, and longer postoperative hospital stays and incurred hospital costs. CONCLUSIONS: Free flap reconstruction did not benefit elderly patients in mouth-opening width or survival analyses; the only quality of life domain that was significantly improved in patients undergoing free flap reconstruction was chewing. Free tissue transfer should be cautiously suggested for elderly patients with advanced oral cancer.

Total lower lip reconstruction with a double mental neurovascular V-Y island advancement flap.

PURPOSE: To assess the effectiveness of double mental V-Y island advancement flaps for total lower lip reconstructions. MATERIALS AND METHODS: During a 6-year period, from 2006 to 2012, total lower lip reconstruction was performed in 12 patients using double mental V-Y island advanced flaps. The resulting lip function and superiority of each flap were analyzed. To assess any cosmetic implications, patients were asked to answer the Appearance Domain section from the University of Washington Quality of Life Questionnaire at least 12 months after discharge from the hospital. RESULTS: All flaps survived completely and no short-term postoperative complications occurred. The mean follow-up time was 34.5 months (range, 15 to 69 months) and there was no recurrence of disease. All patients were capable of consuming a regular oral diet and no patients complained of an inability to eat in a public setting, drooling, or microstomia. The mean preoperative and postoperative open-mouth widths were 4.1 and 3.7 cm, respectively, and the mean reduced open-mouth width was 10%. The intercommissural width varied from 4.6 to 6.8 cm (mean, 5.5 cm). The mean postoperative 2-point discrimination was 11.2 mm (range, 9 to 13 mm). The mean score for the Appearance Domain section was 93.8 (range, 75 to 100). CONCLUSION: The mental V-Y island advancement flap reconstruction is a reliable procedure for total lower lip reconstruction.

Submental versus platysma flap for the reconstruction of complex facial defects following resection of head and neck tumors.

OBJECTIVE: To compare the platysma flap with submental flap in terms of tumor and flap characteristics, operative properties and the functional outcomes. METHODS: A total of 65 patients presented with tumors of head and neck and underwent curative tumor resection with different neck dissections at the Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology of China Medical University; from March 2005 to December 2012 were included in the study. After radical tumor excision and neck dissection the resultant complex defects were reconstructed with either platysma flap or the submental flap. The extent of surgical resection, the type of neck dissection and choice of flap reconstruction was at the discretion of the surgical team. The functional outcomes, operative time and characteristics of both platysma and submental flaps were compared and the statistical tests of significance were applied accordingly. RESULTS: The mean age was 60 years. The complex facial defects of 30 patients were reconstructed with platysma flap and of 35 patients with submental flap. Mean operation time of submental flap including flap harvesting (5.58±1.96hrs) was shorter than platysma flap (6.2±1.4hrs). The majority of the flaps (88-93%) were taken successfully in both groups. Submental flap was associated with significantly higher patients' satisfaction regarding acceptable functional outcomes (p-value 0.027). The mean reduction in mouth opening was significantly smaller in platysma group (0.37 ±0.18cms) than the submental group (0.47±0.16). CONCLUSION: This study demonstrates that both platysma and submental flap techniques can be used for the reconstruction of complex facial defects with the acceptable functional outcome. The platysma flap can be harvested to medium size defects up to 70cm(2) with good mouth opening. The submental flap is simpler, faster with a wider range of application and more acceptable functional outcomes.

Assessment of the quality of life of patients with oral cancer after pectoralis major myocutaneous flap reconstruction with a focus on speech.

PURPOSE: The aim of the present study was to evaluate the quality of life (QoL) of patients with oral cancer who had undergone resection of the tongue and floor of the mouth and reconstruction with the pectoralis major flap. MATERIALS AND METHODS: The present study assessed 21 patients who had undergone pectoralis major flap reconstruction using the University of Washington QoL, version 4, questionnaire. A nonparametric Mann-Whitney U test was used to analyze the data. RESULTS: Of the 12 disease-specific domains, the best 3 scores from the patients were for pain, saliva, and anxiety, and the worst 3 scores were for taste, chewing, and swallowing. The mean UW-QoL composite score was 73.4. Swallowing was considered to be the most important issue within the previous 7 days, followed by chewing and speech. Those patients who had undergone wider excision had poorer speech. CONCLUSIONS: A significant effect was found on the QoL of patients with oral cancer who had undergone resection of the tongue and floor of the mouth with pectoralis major flap reconstruction.

Clinical reliability of radial forearm free flap in repair of buccal defects.

BACKGROUND: The ideal method for buccal defects should provide good outcome of both function and appearance; our goal is to highlight the reliability of radial forearm flap in buccal reconstruction. METHODS: A retrospective study was conducted. From 2005 to 2012, 20 radial forearm flaps were used to repair the defects. We analyzed the superiority and reliability of the flap; in addition, we reviewed some related literature and made a comparison between radial forearm flap and platysma flap. RESULTS: All radial forearm flaps totally survived, but two flaps suffered venous obstruction, hematoma, respectively. Radial forearm flap preserved the original interincisal distance well. In our follow-up, all patients had sufficient mouth-opening width (mean: 4.3 cm). CONCLUSION: Radial forearm flap is a reliable method for buccal defect reconstruction.

Vertical platysma myocutaneous flap that sacrifices the facial artery and vein.

BACKGROUND: Platysma myocutaneous flap (PMF) is a generally used technique for defect reconstruction after an oral cancer resection. The aim of the study is to present our experience using vertical PMF that sacrificed the facial artery and vein for intraoral reconstruction. METHODS: A retrospective review of the medical records of 54 patients who underwent vertical PMF that sacrificed the facial artery and vein for intraoral reconstruction was performed. A comparison between PMF that sacrificed and that preserved the facial vessels was made, and we also compared PMF that sacrificed the facial vessels with radial forearm free flap (RFFF). Statistics concerning the patients' clinical factors were gathered. RESULTS: The mean age of the 54 patients who underwent PMF that sacrificed the facial artery and vein was 62.0 ± 10.98 years. The co-morbid disease rate of PMF was 53.7%. The flap size ranged from 12 × 5.5 cm to 7 × 5 cm. Survival of the flap was found in all of the cases, with partial necrosis in four cases (7.4%) and total loss in none of the cases. The operation time was 5.7 ± 1.17 h. The complication and success rates were 27.8% and 92.6%, respectively. The 3-year and 5-year survival rates were 77.8% (21/27) and 69.23% (9/13), respectively. The majority of the patients (87.0%) in our series were satisfied with the results of the surgery. There was no significant difference between PMF that sacrificed or that preserved the facial vessels, both in success rate (P = 1) or complication rate (P = 0.72). The patients in the PMF group were older than the patients in the RFFF group (P = 0.011), the operation time was shorter (P < 0.001), and the co-morbid disease rate was higher (P = 0.002). Although the complication rate of PMF (15/54, 27.8%) was higher than that of RFFF (2/34, 5.9%) (P = 0.011), their success rates were similar (92.6%, 94.1%) (P = 1.00). CONCLUSIONS: Vertical PMF that sacrifices the facial artery and vein has specific advantages including in ease preparation and limitations. This technique may provide an effective method for intraoral reconstruction. Our experience in handling the flap may contribute to the success rate.

Comparison studies of different flaps for reconstruction of buccal defects.

Our purpose was to evaluate the feasibility of radial forearm free (RFF) flap, platysma myocutaneous (PM) flap, and anterolateral thigh (ALT) flap in buccal reconstruction. This study consisted of 56 patients who were categorized into 3 groups. The Student t test was used to analyze the variables. Patients in group platysma flap were significantly older, the dissection of platysma flap was easier, and the defect was significantly smaller than those in group radial forearm flap and group ALT flap. The reduction in the widths of mouth opening between group PM, group RFF, and group ALT were compared. However, the reduction of mouth-opening widths in group RFF and group ALT was significantly less than that in group PM. Platysma myocutaneous flap may be more suitable in patients with small to middle-size defect and poor status, although the flap cannot achieve a reliable result; anterolateral thigh flap and radial forearm flap can preserve the interincisal distance well even for large buccal defect, but it takes more time and skills in the operation.

Quality of life in patients younger than 40 years treated for anterior tongue squamous cell carcinoma.

This study investigated the quality of life in patients younger than 40 years with tongue squamous cell carcinoma. We used the University of Washington Head and Neck Quality of Life scale to compare the quality of life outcomes between young and old patients. Cases were patients younger than 40 years who were treated for anterior tongue squamous cell carcinoma. Controls were patients older than 40 years who were matched to the cases regarding diagnosis, sex, and TNM classification. Two controls were matched for each case; thus, 21 cases and 42 controls were selected. Twenty-one of 33 questionnaires (63.6%) were returned. The median follow-up duration was 3.7 years (range, 1-12 y). In the group of young patients, the best-scoring domains were pain, chewing, and swallowing, whereas the lowest scores were for appearance, mood, and anxiety. Young patients (40 years or younger) reported better function, notably regarding activity, recreation, shoulder, taste, and saliva compared with the old patients with anterior tongue squamous cell carcinoma. The patients younger than 40 years tend to have a good quality of life. Most of them were not significantly affected by pain. Quality of life should be used as part of our treatment of anterior tongue squamous cell carcinoma.

A novel flap design technique for subtotal tongue reconstruction with an "Individualized and Convenient Tongue Model".

BACKGROUND: To achieve improved functional outcomes in subtotal tongue reconstruction, a flap design with sufficient volume and appropriate shape is necessary. In this study, we introduce an "Individualized and Convenient Tongue Model" (ICTM) for flap design in subtotal tongue reconstruction. METHODS: By studying the anatomical morphology of the tongue, we found a similar geometry within the dorsum and body of the tongue as well as the mouth floor. This can be used to create an ICTM through folding and splicing. We can simulate tongue defects in the ICTM and transform defect shapes into guide plates for flap design. In this study, fifty-eight patients requiring subtotal tongue reconstruction were randomly divided into two groups: an ICTM group (35 patients) and a conventional group (31 patients). In the ICTM group, we individually designed profunda artery perforator flaps (PAPFs) or anterolateral thigh flaps (ALTFs) using the ICTM method. In the conventional group, the flap was designed according to the surgeon's clinical experience. Patient demographics, operative and follow-up data were recorded. Swallowing, speech intelligibility, and cosmetic results were assessed using appropriate scales. RESULTS: All flaps survived, although there were no significant differences in tumor size, operation time, flap size, and complication rate compared to the conventional group. Patients in the ICTM group had significantly improved speech intelligibility (p = 0.019), cosmetic appearance (p = 0.009), and swallowing ability (p = 0.003). CONCLUSIONS: The ICTM technique is an effective and convenient solution for subtotal tongue reconstruction that provides an individualized flap design and improves functional outcomes compared to the conventional design.

Reconstruction of large defects of anterior floor of mouth with free flaps using a novel individualized flap design method.

The purpose of this study was to introduce a novel individualized flap design method for large anterior floor of the mouth (AFOM) defect reconstruction, review experience with the use of this flap design method for large AFOM defect reconstruction, and assess its functional results. A retrospective study of patients who received large AFOM defect reconstruction with free flaps was conducted. There was a cohort of patients who were treated using the novel individualized flap design method and a cohort without flap design. Functional outcomes were evaluated with appropriate scales. Outcomes were analyzed, and a p-value <0.05 was considered significant. 22 patients received the individualized flap design, while 21 patients were treated without a special flap design. All flaps survived. All free flaps harvested with the novel individualized flap design method better matched AFOM defects. Relative to patients without flap design, patients in the novel individualized flap design group showed significant improvement in speech intelligibility (p = 0.036) and swallowing function (p = 0.019). Within the limitation of the study it seems that large AFOM defect reconstruction with the novel individualized flap design method can not only cover and close the wound to avoid oral-neck fistulae, but also maintains tongue mobility to achieve better functional outcomes than in patients without flap design.

Free posterior tibial artery perforator flap for floor of mouth reconstruction: a case report.

In this report, we present a case with floor of mouth squamous cell carcinoma who underwent wide excision of tumor, a marginal mandibulectomy and bilateral selective neck dissections. A 7 cm × 4 cm fasciocutaneous flap based on a posterior tibial artery perforator (PTAP) from the left posterior leg was harvested to reconstruct a floor of the mouth defect. The donor-site defect was closed primarily. The flap survived in its entirety. No donor or recipient site complications occurred. The patient tolerated a regular diet at 3-month follow-up with normal speech and leg function. To our knowledge, there has been no previous report on the use of the PTAP flap for floor of mouth reconstruction. Our experience has shown the PTAP flap could be one of options for small defects.

Digital navigation and 3D model technology in mandibular reconstruction with fibular free flap: A comparative study.

OBJECTIVE: The low accuracy limits the use of fibular free flap (FFF). We apply digital navigation and 3D printing model technology in mandibular reconstruction to improve FFF's accuracy. METHODS: 34 patients who underwent with FFF to repair mandibular defects were divided into Navigation Group (13 cases, using digital navigation and 3D printing model) and Control Group (21 cases, only 3D printing model). We retrospectively reviewed patients' hospitalization information and evaluated patients by subjective and objective items, such as UW-Qol scale, CT data. RESULTS: The operation time of Navigation Group was higher significantly than Control Group (10.36 ± 1.87vs9.00 ± 1.34 h).There were no significant differences in early postoperative complications. The Qol score of appearance, motion, anxiety were higher significantly in Navigation Group. The CT results showed that mandibular angle deviation and chin deflection of Navigation Group were better significantly than Control Group (1.72 ± 1.29° vs 3.69 ± 1.67°, 2.45 ± 1.39 vs 5.19 ± 2.13 mm). CONCLUSIONS: The digital navigation can improve FFF's accuracy in mandibular reconstruction. It doesn't significantly increase complications. The digital navigation's installation and operation methods should be simplified to shorter operation time and expand its application.

Assessment of fibula flap with flexor hallucis longus's effect on head & neck tumor patients' quality of life and function of donor site.

OBJECTIVE: Free fibular flaps (FFFs) have been widely used in mandibular reconstruction. It is still unclear whether retaining flexor hallucis longus (FHL) is needed for flaps. This study introduces a comparison in quality of life and donor-site function between those who have and haven't harvested FHL with FFF. METHODS: Patients with FFFs were single-blind-randomly assigned into the FHL group or nFHL group. Patients were followed up preoperatively and 1, 3 and 6 months postoperatively via subjective evaluations (SF-36/AOFAS) and objective evaluation s(muscle strength and range of motion). Patients' hospitalization and intraoperative information, donor site morbidity were recorded. RESULTS: Each group had 15 patients. The flap harvesting time in FHL group was shorter significantly than nFHL group (125.9 ± 24.8 min vs 146.7 ± 29.9 min, P = 0.048). There were no significant differences in hospitalization information such as operation time, hospitalization days and cost. Donor site morbidities at 1, 3 and 6 months postoperatively showed no significant differences except for the presence of claw toes (nFHL group > FHL group, 40% vs 0, P = 0.017; 53.3% vs 6.7%, P = 0.014; 60.0% vs 13.3%, P = 0.021). There were no significant differences in SF-36 and AOFAS scores. There were no significant differences in muscle strength and range of motion. CONCLUSION: Excision of the FHL lowered the flap harvesting time. It did not increase donor site morbidity. The impacts on patients' quality of life and foot function were the same. The surgeons can use the FHL without considering the influence on patients if not retaining the FHL.

[Assessment of life quality of for patients after tongue reconstruction with radial forearm free flap, anterolateral thigh perforator flap or submental island flap].

PURPOSE: The aim of this study was to evaluate operation-related factors and quality of life (QOL) for patients after tongue reconstruction with radial forearm free flap (RFFF), anterolateral thigh perforator flap (ALT) or submental island flap (SIF). METHODS: Totally 59 patients, diagnosed as tongue carcinoma, received glossectomy and simultaneous reconstruction with free flaps including RFFF, ALT or SIF in the Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, China Medical University from October 2004 to October 2014. All patients were followed up for 6 months and completed the University of Washington Quality of Life scale Version 4 questionnaires. The postoperative QOL was compared among the three groups. The data were analyzed using SPSS 21.0 software package. RESULTS: The operation duration of SIF group was significantly shorter than those of RFFF group or ALT group (P<0.05). The ALT group had a longer hospitalization time. There were statistically differences among the 3 groups regarding to the size of reconstructed defects. Action QOL score of the ALT group was significantly lower than those of RFFF group and SIF group. There was no significant difference in the total QOL score including chewing, swallowing, speech and postoperative pain among the 3 groups. CONCLUSION: In summary, there may be functional disability for patients after glossectomy and simultaneous reconstruction. The quality of life would be acceptable after tongue reconstruction with RFFF, ALT and SIF.

A comparison of mandible preservation method and mandibulotomy approach in oral and oropharyngeal cancer: A meta-analysis.

OBJECTIVE: This study aims to compare the prognoses outcomes of mandibular preservation method (MPM) and the mandibulotomy approach (MLA) in oral and oropharyngeal cancer (OOPC) patients. METHOD: We searched PubMed, Web of Science, EMBASE, Chinese BioMedical Literature Database (CBM), Cochrane Library, and clinicaltrials.gov up to September 2016 to identify the studies that compared the prognoses of the MPM versus the MLA in OOPC patients. Two authors individually extracted the data and performed quality assessment. The surgical margins, overall survival rate, total and local recurrence rates, fistula formation, and other functional outcomes were evaluated. RESULT: Six studies with 309 patients were included in our analysis. No significant difference was found regarding the surgical margins, overall survival rate, total and local recurrence rates, and speech and tongue movement between the MPM and MLA groups. However, the MPM group showed a significantly lower fistula formation rate than the MLA group after the operation. CONCLUSION: These findings suggest that the MPM may provide a similar clinical outcome to the MLA, but that the MPM has a lower complication rate in the treatment of OOPC patients.

Total and near-total lower lip reconstruction: 20 years experience.

BACKGROUND: Reconstruction of total and near-total lower lip defects presents a formidable challenge for the reconstructive plastic surgeon. Many methods have been described, and each has its own advantages and disadvantages. The aim of this article is to discuss the selection of techniques and report our experience of total or near-total lower lip reconstruction. MATERIAL AND METHODS: Over a 20-year period from January 1993 to December 2013, a total of 87 patients underwent total or near-total lower lip reconstruction. Bilateral Yu's flaps were used in 61 patients, double mental neurovascular V-Y island advancement flaps in 16 patients, bilateral Mutaf's techniques in 4 patients, and reconstruction with free radial forearm flaps in 6 other patients. Drooling Rating Scale (DRS) and Patient and Observer Scar Assessment Scale (POSAS) were used to evaluate oral competency and esthetic outcomes. RESULTS: All patients underwent single-stage total or near-total lower lip reconstruction successfully. There were no flap failures. Only 1 patient who accepted the bilateral Yu's flaps developed microstomia, having difficulty in wearing her dentures postoperatively. Oral competencies were well preserved in other patients, and esthetic results were satisfactory. CONCLUSION: Based on our experience, we recommend using the bilateral local techniques or free flap introduced in this article, according to the extent of defects and the patient's general condition, to achieve a personalized ideal reconstruction of the lower lip.

Assessment of quality of life of patients with oral cavity cancer who have had defects reconstructed with free anterolateral thigh perforator flaps.

The aim of this study was to evaluate quality of life (QoL) in patients who have had resections of oral cancer and reconstruction by free anterolateral thigh perforator flaps. QoL was assessed by the 14-item Oral Health Impact Profile (OHIP-14) and the University of Washington Quality of Life (UW-QoL) questionnaires 12 months postoperatively. Fifty-one of the 69 questionnaires were returned (74%). In the UW-QoL the best-scoring domain was pain, whereas the lowest scores were for chewing, saliva, and taste. In the OHIP-14 the lowest-scoring domain was handicap, followed by psychological disability, and social disability. Free anterolateral thigh perforator flaps for reconstruction of defects of the head and neck after resection for cancer significantly influenced the patients' quality of life.

Clinical anatomical study and evaluation of the use of the free anteromedial thigh perforator flaps in reconstructions of the head and neck.

The anteromedial thigh (AMT) perforator flap is usually thin, pliable, and nearly hairless, making it particularly suitable to repair defects of the head and neck. We studied the topography and outcomes of AMT perforator flaps in such defects after excision of tumours. We retrospectively reviewed the casenotes of 11 consecutive patients who had had reconstructions of the head and neck with the initial intent of using an AMT perforator flap from January 2010 to July 2011. For each patient we recorded the size and thickness of the flap; the length of the pedicle; and the number, external diameters, anatomical types, source vessels, and sites of the sizeable perforators. Of the 11 patients, 10 had successful reconstruction using AMT perforator flaps, but one had no AMT perforator big enough. The mean (range) number of sizeable perforators/flap was 1.3 (1-2), length of pedicle 10.6 (7-13) cm, and diameter of the artery 1.1(1.0-1.5) mm. Of the 13 sizeable perforators, 3 were direct and septocutaneous. The remaining ones were all musculocutaneous. Most of them were located in the middle third of the thigh. Primary closure of the donor site was achieved in all patients. One flap was successfully revised after compression of the perforator. All flaps survived with good functional and aesthetic outcomes. The free AMT perforator flap is suitable for reconstructions of the head and neck if a sizeable perforator can be found. The AMT flap may be used as a primary flap rather than as an alternative to the anterolateral thigh flap or a component of a chimeric flap.