Comparative Analysis of Radial Forearm Free Flap and Anterolateral Thigh Flap in Tongue Reconstruction after Radical Resection of Tongue Cancer

Abstract

<b><i>Background:</i></b> Surgery is still the preferred treatment for tongue cancer. Reconstruction should be performed immediately after extensive resection of the tumor. The purpose of this study was to investigate the clinical effect, advantages, and disadvantages of radial forearm free (RFF) flap and anterolateral thigh (ALT) flap in tongue reconstruction after radical resection of tongue cancer. <b><i>Methods:</i></b> Thirty-nine cases of tongue reconstruction with RFF flap or ALT flap from 2014 to 2018 were analyzed. The survival of the flap, the functional status after repair, and the influence on the donor area were examined, in addition to the advantages and disadvantages of the flap and the critical points of the technique. <b><i>Results:</i></b> Twenty-one cases with RFF flaps and 18 cases with ALT flaps showed complete flap survival. Among them, 1 case involved a venous vessel crisis after an ALT operation, and the flap survived after reoperation after thrombus removal and anastomosis. The recovery of tongue function was as follows: 41.0% patients exhibited normal speech, 43.6% patients exhibited near-normal speech, 12.8% patients exhibited vague speech, and 2.6% patients could not speak. There was no significant difference between the 2 groups (<i>p</i> = 0.134). The recovery of tongue flexibility was as follows: 41.0% of the patients had normal postoperative tongue flexibility, 43.6% of the patients had slightly limited tongue flexibility, 12.8% of the patients had severely limited tongue flexibility, and 2.6% of the patients were completely limited. The difference between the 2 groups was statistically significant (<i>p</i> = 0.045). The postoperative diet of patients was as follows: 51.3% of patients had a regular diet, 33.3% of patients had soft foods, 12.8% of patients received a fluid diet, and 2.6% of patients could not eat after the operation. There was no significant difference between the 2 groups (<i>p</i> = 0.209). The satisfaction of donor area was as follows: 46.2% of the patients were satisfied with the donor area, 51.3% of the patients were basically satisfied with the donor area satisfaction, and 2.6% of the patients were not satisfied with the donor area satisfaction. There was no significant difference between the 2 groups (<i>p</i> = 0.809). <b><i>Conclusion:</i></b> The RFF flap is the most widely used technique in tongue reconstruction, especially in patients with tongue defects less than half of tongue tissue. However, for a large number of tissue defects caused by radical resection of advanced tongue cancer, the ALT flaps can provide a sufficient tissue volume, conceal scars after the operation, cause fewer complications in the donor area, and facilitate tongue function and aesthetic quality.

<p>Short-Term Quality of Life, Functional Status, and Their Predictors in Tongue Cancer Patients After Anterolateral Thigh Free Flap Reconstruction: A Single-Center, Prospective, Comparative Study</p>

“…13 Compared to other tissue flaps, ALTFF is superior in terms of being an adequately sized flap, sparing major vasculature, and having better cosmesis at both donor and recipient sites. 14 The apparent success and popularity of ALTFF reconstruction are due to the surgical technique. However, there is limited knowledge regarding its success in improving the functional status and overall quality of life of patients.…”

Case Report: Superficial Circumflex Iliac Artery Perforator Flap for Tongue Reconstruction Following the Hemiglossectomy

“…One of the most challenging surgeries after the removal of lesions in oral cancers is tongue reconstruction ( 13 ). As the critical sensory organ for speech and swallowing, the tongue plays a central role in the postsurgical day-to-day life of patients while eating and talking.…”

Current status and evolution of microsurgical tongue reconstructions, part I

“…However, donor site morbidity is a particularly important consideration when applying the RFFF, particularly in terms of skin graft coverage and issues related to partial graft take, tendon exposure, scar sensitivity, and pinch and grip strength. Furthermore, it is necessary to perform the Allan test preoperatively to ensure adequate hand vascularity because the flap involves harvesting the radial artery as its pedicle [ 22 , 25 ]. Despite these limitations, the RFFF has been associated with favorable functional outcomes superior to those offered by other options [ 25 ].…”

“…Furthermore, it is necessary to perform the Allan test preoperatively to ensure adequate hand vascularity because the flap involves harvesting the radial artery as its pedicle [ 22 , 25 ]. Despite these limitations, the RFFF has been associated with favorable functional outcomes superior to those offered by other options [ 25 ].…”