Neurotized profunda artery perforator flap for subtotal tongue reconstruction – Prospective case series

Abstract

BackgroundTotal or subtotal glossectomy defects cause significant functional deficits in swallowing and speech and subsequently impair patients’ quality of life. Recently, the profunda artery perforator (PAP) flap has emerged as a potential alternative for reconstructing extensive glossectomy defects. While previous studies assessing recovery of neurotized ALT flaps in head and neck reconstruction reported superior sensory recovery, improved swallow function, and improved overall patient satisfaction in patients with neurotized flaps vs. non-neurotized ALT flap reconstruction, PAP flap neurotization has not been described and systematically assessed in head and neck patients. MethodsSix patients underwent subtotal tongue reconstruction with neurotized PAP flaps at the authors’ institution from May 2022 until August 2023. A branch of the posterior femoral cutaneous nerve of the PAP flap was coaptated to the lingual nerve. Two-point discrimination, Semmes-Weinstein monofilament, pain, and temperature assessments were conducted at 3, 6, and 12 months postoperatively on the neo-tongue. The MD Anderson speech and deglutition scales and the EORTC-QLQ-H&N35 were used to record functional outcomes and QOL. ResultsMean age was 69±4 years and mean BMI was 25±7kg/m2. Neo-tongue median two-point discrimination at the tip improved from >10mm at 3 months to 6mm at 12 months. All patients had protective pain and temperature perception at the neo-tongue tip at 6-month follow-up. Speech and swallowing function were similar at 12 month follow-up compared with data on neurotized ALT flaps from literature. No neuropathic pain was reported at the donor site at 6-month follow-up. ConclusionsThis is the first case series of PAP flap neurotization in head and neck patients, suggesting potential functional advantages with minimal donor site morbidity. Level of evidenceV Case Series