Objectives: The aim of the study was to evaluate the functional and aesthetic outcomes on donor and recipient sites and to determine the effects of technical factors including flap thickness and vessel diameters measured by ultrasonography as well as the size of the defect and postoperative volume reduction of the flaps measured by magnetic resonance imaging (MRI). Methods: In patients who had undergone soft tissue reconstructive surgery between March 2013 and March 2016 using 55 anterolateral thigh flaps (ALTFs), 30 radial forearm flaps (RFFs), and 18 latissimus dorsi flaps (LDFs), color Doppler ultrasonography was performed to measure the thickness of the flap at the site of the perforator. Preoperative color Doppler ultrasound examinations of the blood vessel diameters of donor and recipient sites were carried out. Results: 97.1% of flaps showed complete survival and 2.9% complete failure (2 ALTFs and 1 LDF). The difference in flap volume of ALTFs, RFFs, and LDFs between MRI 1 (3-6 weeks) and MRI 2 (6-18 months) was 27.6, 17.9, and 36.1%, respectively. Conclusion: Proper selection of the flap is important for the optimization of the aesthetic and functional outcomes. Ultrasound, the surgeon's experience and the extension and nature of the defect play a key role in the selection of the flap.

1.
Demirkan F, Chen HC, Wei FC, Chen HH, Jung SG, Hau SP, Liao CT: The versatile anterolateral thigh flap: a musculocutaneous flap in disguise in head and neck reconstruction. Br J Plast Surg 2000;53:30-36.
2.
Disa JJ, Pusic AL, Hidalgo DH, Cordeiro PG: Simplifying microvascular head and neck reconstruction: a rational approach to donor site selection. Ann Plast Surg 2001;47:385-389.
3.
Abubaker AO, Abouzgia MB: The temporalis muscle flap in reconstruction of intraoral defects: an appraisal of the technique. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;94:24-30.
4.
Ariyan S: The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck. Plast Reconstr Surg 1979;63:73-81.
5.
McConnel FM, Pauloski BR, Logemann JA, Rademaker AW, Colangelo L, Shedd D, Carroll W, Lewin J, Johnson J: Functional results of primary closure vs flaps in oropharyngeal reconstruction: a prospective study of speech and swallowing. Arch Otolaryngol Head Neck Surg 1998;124:625-630.
6.
McGregor IA: The pursuit of function and cosmesis in managing oral cancer. Br J Plast Surg 1993;46:22-31.
7.
McGregor IA, McGrouther DA: Skin-graft reconstruction in carcinoma of the tongue. Head Neck Surg 1978;1:47-51.
8.
Chim H, Salgado CJ, Seselgyte R, Wei FC, Mardini S: Principles of head and neck reconstruction: an algorithm to guide flap selection. Semin Plast Surg 2010;24:148-154.
9.
Kimata Y, Uchiyama K, Ebihara S, Nakatsuka T, Harii K: Anatomic variations and technical problems of the anterolateral thigh flap: a report of 74 cases. Plast Reconstr Surg 1998;102:1517-1523.
10.
Talegon-Melendez A, Ciria-Llorens G, Gomez-Cia T, Mayo-Iscar A: Flow changes in forearm arteries after elevating the radial forearm flap: prospective study using color duplex imaging. J Ultrasound Med 1999;18:553-558.
11.
Sun G, Lu M, Hu Q, Tang E, Yang X, Wang Z: Clinical application of thin anterolateral thigh flap in the reconstruction of intraoral defects. Oral Surg Oral Med Oral Pathol Oral Radiol 2013;115:185-191.
12.
Shaw RJ, Batstone MD, Blackburn TK, Brown JS: Preoperative Doppler assessment of perforator anatomy in the anterolateral thigh flap. Br J Oral Maxillofac Surg 2010;48:419-422.
13.
Sakuraba M, Asano T, Miyamoto S, Hayashi R, Yamazaki M, Miyazaki M, Ugumori T, Daiko H, Kimata Y: A new flap design for tongue reconstruction after total or subtotal glossectomy in thin patients. J Plast Reconstr Aesthet Surg 2009;62:795-799.
14.
Shah JP, Gil Z: Current concepts in management of oral cancer - surgery. Oral Oncol 2009;45:394-401.
15.
Yun IS, Lee DW, Lee WJ, Lew DH, Choi EC, Rah DK: Correlation of neotongue volume changes with functional outcomes after long-term follow-up of total glossectomy. J Craniofac Surg 2010;21:111-116.
16.
Cho KJ, Joo YH, Sun DI, Kim MS: Perioperative clinical factors affecting volume changes of reconstructed flaps in head and neck cancer patients: free versus regional flaps. Eur Arch Otorhinolaryngol 2011;268:1061-1065.
17.
Fujioka M, Masuda K, Imamura Y: Fatty tissue atrophy of free flap used for head and neck reconstruction. Microsurgery 2011;31:32-35.
18.
Hallock GG: Long-term superiority of composite versus muscle-only free flaps for skull coverage. Ann Plast Surg 2004;52:507-510; discussion 510-511.
19.
Devon RK, Rosen MA, Mies C, Orel SG: Breast reconstruction with a transverse rectus abdominis myocutaneous flap: spectrum of normal and abnormal MR imaging findings. Radiographics 2004;24:1287-1299.
20.
Sakamoto Y, Takahara T, Ota Y, Aoki T, Yamazaki H, Otsuru M, Takahashi M, Aoyama K, Kaneko A, Kawada S, Ichikawa T, Imagawa K, Miyasaka M: MRI analysis of chronological changes in free-flap volume in head and neck reconstruction by volumetry. Tokai J Exp Clin Med 2014;39:44-50.
21.
Kimata Y, Sakuraba M, Hishinuma S, Ebihara S, Hayashi R, Asakage T, Nakatsuka T, Harii K: Analysis of the relations between the shape of the reconstructed tongue and postoperative functions after subtotal or total glossectomy. Laryngoscope 2003;113:905-909.
22.
Kiyokawa K, Tai Y, Inoue Y, Yanaga H, Mori K, Nakashima T: Functional reconstruction of swallowing and articulation after total glossectomy without laryngectomy: money pouch-like reconstruction method using rectus abdominis myocutaneous flap. Plast Reconstr Surg 1999;104:2015-2020.
23.
Joo YH, Hwang SH, Sun DI, Park JO, Cho KJ, Kim MS: Assessment of volume changes of radial forearm free flaps in head and neck cancer: long-term results. Oral Oncol 2011;47:72-75.
24.
Bittermann G, Thonissen P, Poxleitner P, Zimmerer R, Vach K, Metzger MC: Microvascular transplants in head and neck reconstruction: 3D evaluation of volume loss. J Craniomaxillofac Surg 2015;43:1319-1324.
25.
Ross GL, Dunn R, Kirkpatrick J, Koshy CE, Alkureishi LW, Bennett N, Soutar DS, Camilleri IG: To thin or not to thin: the use of the anterolateral thigh flap in the reconstruction of intraoral defects. Br J Plast Surg 2003;56:409-413.
26.
Sharabi SE, Hatef DA, Koshy JC, Jain A, Cole PD, Hollier LH Jr: Is primary thinning of the anterolateral thigh flap recommended? Ann Plast Surg 2010;65:555-559.
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