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

Abstract

Summary: Tongue cancer is the most common malignant neoplasm of the oral cavity. Occurrence in the tip of the tongue (TOT) is rare. We describe a case report of a TOT tumor excision and reconstruction with a prelaminated fasciomucosal radial forearm free flap. A 41-year-old white man was referred to our department for a squamous cell carcinoma of the tip of the tongue. The patient worked as an air traffic control official; therefore, conservation of speech intelligibility, both in Italian and English language, was of paramount importance. A transoral excision of TOT, bilateral selective neck dissection, and reconstruction with prelaminated fasciomucosal radial forearm free flap were performed. Adjuvant radiotherapy was necessary. The patient was completely re-established as an air traffic control officer. Successful tongue reconstruction of smaller defects depends on thinness, pliability of flap, and conservation of tongue mobility. Surgical options for TOT reconstruction are facial artery muscolomucosa flap, Zhao flap, radial forearm free flap, or primary suture. In the authors’ opinion, a fasciomucosal prelaminated RFFF offers a series of advantages for TOT reconstruction. The absence of subcutaneous tissue makes the PFRFFF much thinner than fascio-cutaneous flaps. Compared with mucosal loco-regional flaps, prelaminated flaps allow the preservation of oral mucosa lining while providing adequate bulk and reduced scar formation for optimal func- tional recovery. In our case report, the fasciomucosal flap allowed an adequate reconstruction of TOT volume with good functional and aesthetic outcomes. The flap’s added bulk and its minimal scar retraction granted free tongue movement and optimal speech intelligibility.

Prelaminated flaps in head and neck cancer reconstructive surgery: A systematic review

“…A total of 19 studies was included in this systematic review, as showed by the PRISMA flow diagram (Figure 1 ) (Alves et al, 2020 ; Chiarini et al, 2002 ; Collar & Byrne, 2013 ; Colletti et al, 2012 ; Jehn et al, 2019 ; Kilinc & Aytekin, 2014 ; Kim et al, 2013 ; Lauer et al, 2001 ; Maruccia et al, 2020 ; Nehrer‐Tairych et al, 2002 ; Poeschl et al, 2003 ; Rath et al, 1999 ; Sadigh & Jeng, 2015 ; Schlenz et al, 2001 ; Teng et al, 2005 ; Upton et al, 1994 ; Wolff et al, 1996 ; Ziegler & Oyer, 2021 ). Seven out of the selected 19 articles were case reports (Alves et al, 2020 ; Collar & Byrne, 2013 ; De Santis et al, 2020 ; Maruccia et al, 2020 ; Sadigh & Jeng, 2015 ; Teng et al, 2005 ; Ziegler & Oyer, 2021 ), while the remaining 12 articles were case series (with five out of them including less than five cases) (Chiarini et al, 2002 ; Colletti et al, 2012 ; Jehn et al, 2019 ; Kilinc & Aytekin, 2014 ; Kim et al, 2013 ; Lauer et al, 2001 ; Nehrer‐Tairych et al, 2002 ; Poeschl et al, 2003 ; Rath et al, 1999 ; Schlenz et al, 2001 ; Upton et al, 1994 ; Wolff et al, 1996 ). The whole study population was represented by 102 patients (63 males, 30 females, 9 not specified) undergoing reconstruction of an anatomical defect secondary to oncological ablative surgery with a prelaminated flap, over the last 27 years (1994–2021).…”

“…On the contrary, only 5.9% of patients from group C (reconstruction with prelaminated flap as a primary cancer treatment) encountered post‐operative complications. Only in two patients within group C data regarding adjuvant radiation therapy were reported, with a satisfactory morphological and functional results (Chiarini et al, 2002 ; De Santis et al, 2020 ). It was not possible to evaluate data regarding duration of hospitalization and long‐term complications, since data regarding surgical outcome achieved a mean follow‐up of 17 months (range 0.5–30.4).…”

“…showed a longer time of prelamination, even if not reaching statistically significance. This multimodal therapeutic strategy theoretically grants a better preparation of the flap, which can sufficiently grow over time (Rath et al, 1999) Santis et al (2020), chose to wait only 3 weeks before the harvest of the prelaminated flap and neither neoadjuvant radiotherapy nor chemotherapy was not used in any of their patients. The authors stated that this amount of time was enough to reach a great increase of the size of the graft, due to the intense mitotic activity of the oral mucosa and the high vascularization of the fascia antibrachialis (Chiarini et al, 2002).…”

Breast Cancer-Related Lymphedema: Recent Updates on Diagnosis, Severity and Available Treatments

“…Accurate physical examination and assessment of the lymphedema severity are essential to provide more predictable outcomes. A prompt management of the disease in a multidisciplinary team is the key to obtain good results [ 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 ]. Despite the fact lymphedema is still considered an incurable disease, in the last decade promising results with significant reduction of the limb swelling and improvement of psychosocial well-being have been shown.…”

Upper limb traumatic injuries: A concise overview of reconstructive options

“…Of note, the surgical background can significantly interfere with the surgeon's choices in traumatic emergencies as well as in elective procedures both in hand and plastic surgery [ 37 ]. Different surgical aspects have to be taken into considerations when facing with the patient: detailed knowledge of the topic and all surgical solutions [ 38 ]; technical possibilities according to hospital class (hub or spoke center) and epidemiologic challenges such as emerging COVID-19 pandemic [ [39] , [40] , [41] , [42] ]; required instruments to perform microsurgery [ [43] , [44] , [45] , [46] , [47] ]; use of new technologies, innovative surgical methods and unconventional devices [ [48] , [49] , [50] , [51] , [52] ]; possibility to refer to skilled consultants; possibility to work in multi-equip with different specialists [ [53] , [54] , [55] , [56] , [57] , [58] ]; selection of high-risk surgical wound complications patients throughout available scores [ 59 , 60 ]; the help of skilled health professionals able to early detect possible complications and promptly start proper care and close follow-up [ 61 , 62 ]. …”