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Patient Preference in Placement of the Donor-Site Scar in Head and Neck Cancer Reconstruction

2008; Lippincott Williams & Wilkins; Volume: 122; Issue: 1 Linguagem: Inglês

10.1097/prs.0b013e31817746a5

1529-4242

James S. Brown, Suraj Thomas, A. Chakrabati, Derek Lowe, S.N. Rogers,

Surgical Sutures and Adhesives

Sir: Although the radial forearm flap has become the workhorse for soft-tissue oral reconstructive surgery in head and neck cancer, there have been concerns regarding the healing and aesthetic result at the donor site.1 As there is often a choice in the selection of the free flap, it seemed appropriate to ask patients whether they have preferences for donor-site scar placement. A questionnaire was designed and piloted that asked patients their preference for the site of a scar (Fig. 1). Three different patient groups (50 patients each) were recruited consecutively over 8 months, with no refusals: group 1, head and neck cancer patients treated with a free flap; group 2, head and neck cancer patients without a free flap; and group 3, maxillofacial outpatients, of similar age. Group 1 patients were also asked how distressed they were by their scar (on a 10-point scale, with 1 being least distressed).Fig. 1.: Patients were asked to rate their level of preference for scar placement on a scale of 1 to 10, where 1 was most preferred and 10 was least preferred. Options for placement were as follows: a, chest; b, lower arm; c, lower abdomen; d, upper thigh; e, shoulder blade; f, lower back; g, upper arm; and h, lower leg.The upper thigh flap was the most favored of the soft-tissue flaps, with the lower abdominal flap (or iliac crest) being the most favored for composite grafts (Table 1). The lower leg and chest were clearly the least preferred sites for those who had had a free flap, and the chest was the least preferred site for other patients. Women preferred scarring less than men for each scar site (Table 1), particularly for lower leg and chest scars. Head and neck cancer patients who had a free flap were least concerned (scored lowest). Younger patients (younger than 60 years) scored higher for upper and lower arms and lower legs. These sex and age differences existed within each patient group.Table 1: Mean Level of Preference Score for Placement of Scars by Sex and Age GroupPatients who had undergone free flap surgery were not generally distressed by their scar and scored very low on the 10-point scale (mean score, 2.0). The anterolateral thigh was the most favored flap donor site from an aesthetic viewpoint. The lower abdominal wound, which is similar for the rectus abdominis and the iliac crest donor site, was the most favored for the composite grafts. The least favored donor site was the chest, which was more commonly used in the past for pectoralis major; not surprisingly, women preferred this donor site least. More surprisingly, the lower leg was the second least preferred donor site, with women again finding this site unfavorable. The aesthetics of cancer surgery are important to patients, as is clear for breast and head and neck cancer sufferers.2,3 Very few studies have assessed patient opinion regarding site or type of scar, but these studies make a valid contribution to informing a patient's consent when there is a choice of surgical treatment.4 The anterolateral thigh is becoming widely used after being popularized in the Far East,5 and this study adds further weight in favor of this donor site. Clinicians should not compromise the choice of flap with regard to the ideal reconstruction in the primary site, but avoiding the more peripheral donor sites and the chest seems to be in the patient's best interest. James S. Brown, F.R.C.S. University Hospital Aintree Suraj Thomas, M.F.D.S. University Hospital Aintree Angela Chakrabati, M.Sc. Edgehill College Bideford North Devon Derek Lowe, C.Stat., M.Sc. University Hospital Aintree Simon N. Rogers, F.R.C.S. University Hospital Aintree Liverpool England DISCLOSURE No statement of financial interest or commercial associations are relevant to this article.