Feasibility of dpFAMM flap in Tongue Reconstruction After Facial Vessels Ligation and Radiotherapy- Case Presentation

Abstract

BackgroundSalvage surgery with reconstruction of the second and next primary tongue cancer remains difficult, especially after earlier neck dissection and radiotherapy. In the current report, we describe the feasibility of the extended, double-pedicled facial artery musculomucosal (dpFAMM) flap in the reconstruction of the patient with second primary tongue squamous cell carcinoma, after facial vessels ligation and radiotherapy. Case presentation81-year-old female patient was operated on due to tongue squamous cell carcinoma (SCC) on the left side T3N1M0 in 2019. Bilateral selective neck dissection with tongue reconstruction was performed by island FAMM flap. The patient also suffered from synchronous mucinous breast carcinoma treated with tamoxifen. Second primary SCC of the tongue on the opposite (right) side was detected in 2020. The patient did not agree for surgical treatment therefore radiotherapy was performed. Local recurrence of the tongue cancer of the right side was treated surgically in 2021. Salvage surgery comprised hemiglossectomy and dpFAMM flap reconstruction with uneventful postoperative follow-up.ConclusionsThis case presentation proved that dpFAMM flap can be used in salvage surgery and reconstruction even in patients after ligation of facial vassels, irradiation and in the course of hormone therapy. The flap is easy to handle, has good vascularity and comprises predictable method of reconstruction, especially for patients with severe comorbidities.