{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T05:36:52Z","timestamp":1788068212563,"version":"build-2784847793"},"reference-count":38,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2018,11,28]],"date-time":"2018-11-28T00:00:00Z","timestamp":1543363200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Free tissue reconstruction is reliable in suitable patients but patient selection remains a challenge for the reconstructive surgeon. The anterolateral thigh (ALT) free flap and pedicled pectoralis major myocutaneous flap (PMMF) are two common reconstructive options for a lateral temporal bone resection defect. The threshold at which free tissue reconstruction should be considered over locoregional reconstruction is not defined. We sought to define reconstructive flap choice in the setting of medical comorbidities that may dissuade free tissue transfer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective analysis of lateral temporal bone defects at a single institution was undertaken. The primary outcomes were flap survival, surgical complications and durations of surgery and stay. Data regarding medical comorbidities and potential confounders were examined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixty patients with lateral temporal bone defects were identified. Twenty\u2010four (40%) patients underwent PMMF reconstruction and 36 (60%) were reconstructed with ALT. The former were significantly older (73 versus 62\u2009years), though with similar Anesthesiologists Risk Classification System status. Free\u2010flap reconstruction resulted in significantly less flap loss (two versus six) but a longer operating time (790 versus 671\u2009min).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients suffering head and neck cancer with medical comorbidities can make selection of a suitable reconstruction difficult. We found that while patients undergoing ALT reconstruction were typically younger, the comorbidity profile of those patients was similar to patients undergoing PMMF reconstruction. ALT flaps were more reliable than the PMMF, lending credence to the view that free tissue transfer should be the preferred reconstructive option in suitable candidates and defects.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.14922","type":"journal-article","created":{"date-parts":[[2018,11,28]],"date-time":"2018-11-28T17:52:53Z","timestamp":1543427573000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Anterolateral thigh versus pectoralis major flaps in reconstruction of the lateral temporal bone defect"],"prefix":"10.1111","volume":"89","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7715-9464","authenticated-orcid":false,"given":"Justin M.","family":"Parr","sequence":"first","affiliation":[{"name":"Faculty of Medicine The University of Queensland  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prem","family":"Chouhan","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Princess Alexandra Hospital  Brisbane Queensland Australia"},{"name":"Faculty of Medicine Imperial College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Wagels","sequence":"additional","affiliation":[{"name":"Faculty of Medicine The University of Queensland  Brisbane Queensland Australia"},{"name":"Department of Plastic and Reconstructive Surgery Princess Alexandra Hospital  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,11,28]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.131.1.27"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199108000-00014"},{"key":"e_1_2_7_4_1","first-page":"371","article-title":"Head and neck cancer in elderly patients: is microsurgical free\u2010tissue transfer a safe procedure?","volume":"32","author":"Tarsitano A","year":"2012","journal-title":"Acta Otorhinolaryngol. 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