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

Study Overview
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Brief Summary
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Anterolateral thigh (ALT) free flap tissue transfer is a commonly used method of head and neck reconstruction after head and neck cancer removal. The procedure involves removing some muscle, skin, and tissue from the thigh, and this may affect leg function. The purpose of this study is to determine the impact of ALT on ambulation and activities of daily living (ADLs)

Detailed Description
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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.

Official Title
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Does Harvesting an Anterolateral Thigh (ALT) Flap Impact Lower Extremity Function and Activities of Daily Living (ADL) in Patients Undergoing Reconstructive Surgery for Head and Neck Cancer

Conditions
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Free Tissue Flaps, Head and Neck Neoplasms

Intervention / Treatment
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* Other: surveys, evaluative tests for leg function


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Over age 18; Head and neck cancer; To undergo anterolateral thigh free tissue transfer for head and neck reconstruction Exclusion Criteria: Inability to ambulate independently prior to surgery; Inability to negotiate stairs prior to surgery; Inability to follow simple commands; Inability to negotiate stairs prior to surgery; Previous free flap harvest from either lower extremity

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Other: surveys, evaluative tests for leg function|See outcome measures|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Lower Extremity Functional Scale | The Lower Extremity Functional Scale (LEFS) is a validated self-report measure designed to assess the functional capabilities of patients with any lower extremity related musculoskeletal condition. Subjects will be assessed for a change from pre- to post-operative | Pre- and Postoperative - subjects will be followed until discharge, and assessed again at 1 month follow-up | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Lower Extremity Function | Standing on one leg and walking, specifically duration of standing on one leg in minutes and distance walked up to 100 ft. Subjects will be assessed from pre-to-postoperative to determine the decline in leg function. | Pre- and Postoperative - subjects will be followed until discharge, and assessed again at 1 month follow-up | 
| Functional Independence Measure | The Functional Independence Measure (FIM) will assess subject ability to perform activities of daily living such as bathing, lower body dressing, toileting, bed to chair transfer, toilet transfer, walking on level and stairs, social interaction, problem solving and memory. We will assess the change from pre- to post-operative | Pre- and Postoperative - subjects will be followed until discharge, and assessed again at 1 month follow-up | 
| Lower Extremity Strength | Dynamometry will be performed in seated position to determine a change in muscle strength from pre- to post-operative | Pre- and Postoperative - subjects will be followed until discharge, and assessed again at 1 month follow-up |