Background
Squamous cell carcinoma of the tongue is the most common intraoral malignancy. The majority of the cancers are located on the anterior two-thirds of the tongue. Therefore this cancer can often be treated with a hemiglossectomy. Free-tissue transfer is often required to reconstruct the defect on the floor of the mouth. The radial forearm free flap has been the most commonly used flap to drape the floor of the mouth. The simplest way to close the donor site is to use a split thickness skin graft. Skin grafting requires the creation of an additional wound as the donor site for the skin. Problems with graft take can hamper the postoperative progress or delay discharge from the hospital. Moreover, skin graft closure of the donor site leaves a visible contour defect in the forearm of the patient that underwent this procedure. We present a novel technique for tongue reconstruction that uses acellular cadaveric dermis to pre-laminate the radial forearm free flap. We believe that our method can help reduce the donor site morbidity while achieving similar functional results with the reconstruction.
Methods
Sixteen consecutive patients requiring subtotal glossectomies for tongue malignancy underwent a two stage procedure to reconstruct the tongue using a pre-laminated radial forearm free flap between April 2006 and April 2009. A functional assessment of swallowing and speech of this group of patients was performed. The results were compared to those of nine other patients with the same diagnosis who underwent similar resections but had their reconstruction performed with a standard radial forearm free flap.
Results
All patients that underwent tongue reconstruction using the acellular cadaveric dermis achieved comparable results to the control group in terms of range of motion, pain strength, speech, swallowing, and appearance of the donor site. All 16 patients in the experimental group did not require split thickness skin grafting for closure of the forearm donor site.
Conclusions
The use of acellular cadaveric dermis to pre-laminate the radial forearm free flap for tongue reconstruction demonstrated to be a safe, reliable, versatile and convenient method for intraoral reconstruction. All of the patients experienced an improved the appearance of the forearm donor site by eliminating the need for skin grafting. The possibility of permanently disturbing hand function is reduced while it also eliminates the potential transfer of hair to the mouth of the patient. Our technique achieved excellent functional outcomes while reducing the morbidity associated with procedure.