Leg Function and ADL After ALT Reconstruction for Head and Neck Cancer

The ALT flap may be harvested as a subcutaneous, fasciocutaneous, musculocutaneous, or
adipofascial flap. At our institution, three surgeons commonly use this method of free
tissue transfer to reconstruct such defects. In our experience, patients following harvest
of ALT flap have impairments in lower extremity function that result in decreased
independence with transfers, gait and ability to independently perform ADLs. Consequently,
these patients receive Physical and Occupational Therapy following surgery and a number of
patients go on to receive therapy in a rehabilitation facility and/or as an outpatient. A
number of studies have examined donor site morbidity and lower extremity function following
ALT flap harvest. These studies, however, are heterogeneous and primarily use patient
reported and non-standardized scales as outcome measures. Additionally, there is a paucity
of literature related to Physical Therapy and Occupational Therapy outcomes and intervention
with this patient population, despite frequent referral of these patients for post-surgical
therapy.

This investigation will utilize the Lower Extremity Functional Scale, the Functional
Independence Measure, dynamometry, video analysis of a single leg squat and walking speed in
an effort to better assess the affect of ALT harvesting on patients' functional capacity
post operatively. These tests are valid and reliable measures commonly utilized in Physical
Rehabilitation.

Inclusion Criteria:

1. Over age 18;

2. Head and neck cancer;

3. To undergo anterolateral thigh free tissue transfer for head and neck reconstruction

Exclusion Criteria:

1. Inability to ambulate independently prior to surgery;

2. Inability to negotiate stairs prior to surgery;

3. Inability to follow simple commands;

4. Inability to negotiate stairs prior to surgery;

5. Previous free flap harvest from either lower extremity