Free chimeric LD + SA flap for tongue and suprahyoid muscles reconstruction after total glossectomy

Abstract

Background: This study aimed to report the functional outcomes of patients who underwent total or near total glossectomy for oral SCC reconstructed with a chimeric latissimus dorsi and serratus anterior (LD + SA) flap.

Methods: Thirty-two patients with tongue cancer, with a mean age of 48.8 years, were included in the study. All patients underwent total or near total glossectomy and subsequent reconstruction with chimeric LD + SA flap. Swallowing and speech functions were measured and prospectively recorded pre- and 3,6 and 12 months postoperatively. Patient-reported outcomes were measured using the Speech Handicap Index (SHI), M.D. Anderson Dysphagia Inventory (MDADI), and EORTC-QLQ-H&N 35 score at 12 months. Additionally, volume reduction in the flaps was measured.

Results: The mean follow-up period was 21 months (range, 2-67 months). The flaps were successfully placed in 30 cases. The total success rate was 93.8% (30/32). In 25 cases (83,3%), a positive functional outcome was recorded, defined as the achievement of an adequate swallowing and speech ability. The swallowing evaluation study revealed that 83% (25/30) of patients experienced bolus transit. Speech function was assessed 3, 6, and 12 months prospectively by speech therapist, with patient-reported SHI outcomes at 12 months. Speech intelligibility was good in 16,7% of cases (5/30, mean SHI 29.18, SD 16.36) acceptable in 56,7% (17/30, mean SHI 51.14, SD 19.8) and poor intelligibility in 26,7% (8/30, mean SHI 65.62 SD 9.8) at 12 months. Mean MDADI score was 84.5 (SD 12.15), indicating good swallowing function. Decannulation was possible in 25 of the 30 patients (83,3%).

Conclusion: The chimeric LD + SA free flap represents a feasible option for tongue reconstruction after salvage glossectomy, with promising functional outcomes and low donor-side morbidity. This approach significantly improved the patients' oral functions and quality of life.

Keywords: Chimeric flap; Functional tongue reconstruction; Glossectomy; Oral surgery; Tongue cancer.