Reconstruction with Rectus Abdominis Myocutaneous Flap for Total Glossectomy with Laryngectomy

Abstract

From October 1999 to July 2005, defects after total glossectomy with laryngectomy (TGL) for cancer of the tongue or middle pharynx were reconstructed with rectus abdominis myocutaneous (RAMC) flaps in nine patients. The skin flaps were designed larger in width than the original defect to create a funnel-shaped oropharynx and prevent stricture. Six patients had uneventful postoperative courses and began to eat perorally 8 to 15 days postoperatively. One patient suffered flap necrosis due to arterial thrombosis and two patients had leakage. Eventually, eight patients could eat soft foods or gruel, except one patient who had ingested food through a gastrostomy preoperatively. When TGL was performed without mandibulectomy, the blood supply for the remnant mucosa of the backside of the mandible is generally not good, for which the reconstruction with the overlapping deepithelialized flap and muscle is useful for prevention of the fistula formation. We considered that the RAMC flap is a good option for reconstruction after TGL.

Total or subtotal glossectomy with microsurgical reconstruction: Functional and oncological results

“…To avoid this complication, Okazaki et al 17 suggested widening the part of the flap corresponding to the oral floor, de-epithelializing this, and inserting it just below the anterior suture line. In this way, a portion of subcutaneous tissue is placed between the skin and the mucosa and it can be sutured to the mandibular bone.…”

Closure of laryngectomy defects in the age of chemoradiation therapy

“…28 The flap, which needs to be about 10 cm wide, can be used to line the floor of the mouth and used as a patch for partial pharyngectomy defects or tubed to reconstruct circumferential pharyngeal defects. In patients with adequate skin laxity, the donor-site defect can be closed primarily.…”

Tongue reconstruction with minimal donor site morbidity using a deep inferior epigastric perforator (DIEP) free flap in a 6‐year‐old girl

“…Donor site morbidity should be given particular attention in pediatric cases due to its impact on future growth. There are various flap options for tongue reconstruction, such as the radial forearm free flap (RFFF), anterolateral thigh (ALT) free flap, transverse gracilis myocutaneous (TMG) free flap, and rectus abdominis myocutaneous (RAMC) free flap . RFFF and ALT free flaps are able to achieve ideal tongue reconstruction; however, they are associated with unacceptable donor site scar formation, especially in young female patients.…”

“…There are various flap options for tongue reconstruction, such as the radial forearm free flap (RFFF), anterolateral thigh (ALT) free flap, transverse gracilis myocutaneous (TMG) free flap, and rectus abdominis myocutaneous (RAMC) free flap. [4][5][6][7][8][9] RFFF and ALT free flaps are able to achieve ideal tongue reconstruction; however, they are associated with unacceptable donor site scar formation, especially in young female patients. In addition, ALT flaps obtained from this age group often do not contain sufficient adipose tissue to allow bulky tongue reconstruction.…”