Radial Forearm Free Flap for Reconstruction of a Large Defect after Radical Ablation of Carcinoma of the Tongue and Floor of the Mouth: Some New Modifications

Abstract

Background: A modified radial forearm free flap was designed to rehabilitate function and to reduce the complications at both donor and recipient sites. Methods: Between 2003 and 2007, 15 patients with infiltrating squamous cell carcinoma (T₃–T₄) of the tongue and/or floor of the mouth underwent hemiglossectomy and resection of the floor of the mouth with microvascular reconstruction using a modified radial forearm flap. The mean size of the forearm flap was 7.5 × 14 cm, and the de-epithelialized area was 7 × 6 cm, requiring no skin graft from the abdomen. Speech intelligibility tests were administered to test postoperative speech and the functional oral intake scale was applied to assess the postoperative swallowing function, and patients reconstructed with pectoralis major myocutaneous flap were used for comparison. Results: All the flaps were successfully transferred. No obvious complications were found in either the oral-maxillofacial or forearm region. The speech intelligibility was better in the modified flap group (p < 0.01). An acceptable swallowing function was also achieved, although the difference was not significant (p > 0.05). Conclusions: The modified flap used for reconstructing large defects of the tongue and floor of the mouth might be a valid substitute for pectoralis major myocutaneous flap to improve the outcome in individuals with significant oral carcinoma.

A meta-analysis of the randomized controlled trials on elective neck dissection versus therapeutic neck dissection in oral cavity cancers with clinically node-negative neck

“…Laser provides no distinct oncologic advantages over a standard surgical scalpel. However, it is very important for cure to have at least 1cm free tumor excision margin during surgery [143]. Metastasis of oral squamous cell carcinoma into the lymph nodes of the neck is common and reduces survival of the patient.…”

“…It may therefore be necessary to include neck dissection in the complete surgical treatment of some of these patients. In instances of large oral cavity defect following tumor excision and not permitting direct primary closure, reconstruction with pedicle (such as pectoralis major, latissimus dorsi) or free micro vascular (such as radial forearm, latissimus dorsi, periscapular and antero-lateral thigh) myocutaneous flaps can be used [98,131,143].…”

Relationship between oral intake, patient perceived swallowing impairment, and objective videofluoroscopic measures of swallowing in patients with head and neck cancer

“…It is completed and scored by a health‐care provider based on medical chart review, dietary journals, and/or patient report. Although the FOIS was validated for use within the stroke population, recent clinical trials have extended its use as a primary and secondary outcome measure to patients with head and neck cancer and in some trials it serves as a primary outcome of interest to index change in swallowing function …”

Histological study of postnatal development of mouse tongues

“…The implementation of various flaps, such as the forearm flap, are the major repair methods for tongue defects (9). However, these methods are not able to repair the tongue muscle and gustation function.…”