Abstract
PurposeTo describe the use of a myocutaneous serratus anterior free flap (SAFF) for tongue reconstruction after salvage subtotal (STG) and total glossectomy (TG).MethodsIn this prospective case series, seven patients underwent salvage STG or TG and reconstruction with a myocutaneous SAFF between 10/2015 and 02/2017. Functional and oncologic outcomes were prospectively evaluated. Donor side morbidity was determined using the Disabilities of the Arm, Shoulder and Hand (DASH) score.ResultsSAFF with mean skin paddles of 6.7 cm × 8.7 cm was used in five STG and two TG patients, respectively. There was a 100% flap survival and a mean DASH score of 10.8 reflected normal arm and shoulder function after surgery. One year after salvage surgery, 1 (14.3%) and 4 (57.1%) patients were tracheostomy and gastrostomy tube dependent. Gastrostomy tube dependence was significantly worse in patients with tumors of the base of tongue compared to other tumor sites (p = 0.030) and in patients who underwent transcervical compared to transoral tumor resection (p = 0.008). Local recurrence rate was 57.1% with a disease-free survival of 17.6 months.ConclusionThe myocutaneous SAFF represents a safe and reliable flap for tongue reconstruction after salvage glossectomy with satisfying functional outcomes and low donor side morbidity.
Highlights
Subtotal glossectomy (STG) and total glossectomy (TG) are surgical options in cases of advanced stage or recurrent carcinomas originating from the floor of mouth (FOM), the oral part of the tongue (OT) or base of the tongue (BOT) [1]
A prospective case series was conducted on seven patients who underwent salvage STG and TG with laryngeal preservation, and reconstruction with myocutaneous serratus anterior free flap (SAFF) at the Department of Otolaryngology, Head and Neck Surgery, Medical University of Vienna
Standard dosage of RT was 66–70 Gy and platinum-based chemotherapy regimens were used in those five patients, who received RChT
Summary
Subtotal glossectomy (STG) and total glossectomy (TG) are surgical options in cases of advanced stage or recurrent carcinomas originating from the floor of mouth (FOM), the oral part of the tongue (OT) or base of the tongue (BOT) [1]. Despite necessary extensive tumor resections and adjuvant treatment regimens, poor 3- and 5-year disease-specific survival (DSS) rates of 38–51% and 25–41% are reported, respectively [2,3,4]. Tongue reconstruction remains one of the most challenging problems in head and neck surgery [1,2,3,4,5]. Successful tongue reconstruction includes more than satisfying wound healing, wound closure and survival of free flaps [5]. An increasing number of studies has focused on functional outcomes after reconstruction, such as sufficient oral nutrition and functional, intelligible speech, and how to optimize these functional outcomes [5, 6]. The aim of tongue reconstruction differs depending on whether the OT or the BOT is affected.
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