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.