Exclusive tongue tip reconstruction of hemiglossectomy defects using the underrated lateral arm free flap with bilobed design

Abstract

BackgroundTongue reconstruction is challenging with the unique function and anatomy. Goals for reconstruction differ depending on the extent of reconstruction. Thin and pliable flaps are useful for tongue tip reconstruction, for appearance and mobility. This study reports lateral arm free flap (LAFF) as a safe and optimal option for hemi-tongue reconstruction, especially for tongue tip after hemiglossectomy.MethodsThirteen LAFFs were performed for hemi-tongue reconstruction after hemiglossectomy from 1995 to 2018. Of the 13 patients, seven were male and six were female, age varying from 24 to 64 years.ResultsAll flaps healed uneventfully without complications. Donor sites were closed primarily. The recipient vessels for microvascular anastomosis were mainly superior thyroidal artery, external jugular vein. All patients returned to normal diet, with no complaints regarding reconstructed tongue and donor site.ConclusionThe LAFF is hairless, thin (especially with lateral epicondyle approach), and potentially sensate. They are advantageous features for tongue tip and hemi-tongue reconstruction. Donor site sacrifices the inessential posterior radial collateral artery, and the scar is hidden under short sleeve shirts. We believe that LAFF can be considered as the first choice flap for hemitongue reconstruction, over radial forearm free flaps.

Tip of the Tongue Reconstruction with Prelaminated Fasciomucosal Radial Forearm Free Flap

“…Several authors have demonstrated that radial forearm free flap (RFFF) can be a viable first choice for small to hemiglossectomy defect reconstruction. 5 , 8 , 11 , 12 An ideal reconstruction should replace the deficient tissue with one of similar size, volume and texture. The challenge of TOT reconstruction lies in the perfecting of cosmesis and function and not the only replacement of deficient tissue.…”

“…The challenge of TOT reconstruction lies in the perfecting of cosmesis and function and not the only replacement of deficient tissue. 12 …”

“…Prelamination resolves the necessity for skin grafting in the forearm, one of RFFF’s major disadvantages. 12 …”

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

“…However, surgical treatment usually results in soft tissue defects, and esthetic and functional deficiencies, leading to a decline in the quality of life. With the advancement in microvascular tongue reconstruction, surgeons can restore the oral function of patients by utilizing different flaps ( 3 ).…”

“…According to the classification of tongue resection for tumor removal, we can define tongue defects as subtotal, total glossectomy, and hemiglossectomy ( 3 ). For subtotal glossectomy defects, anterolateral thigh perforator flaps (ALTF) or anterolateral thigh myocutaneous flaps are recommended ( 4 ); for total glossectomy defects, pentagonal anterolateral thigh myocutaneous flaps are preferred ( 5 ); for hemiglossectomy defects, radial forearm free flaps (RFFF), ALTF, and superficial circumflex iliac artery perforator (SCIP) flaps are the available options ( 6 ).…”