Functional reconstruction with free flaps following ablationof oropharyngeal cancer

Abstract

With the development of various reconstructive procedures, most patients who have undergone ablative surgery for oropharyngeal cancer have obtained satisfactory functional results and good quality of life. However, many questions remain concerning methods of obtaining optimal postoperative oral and pharyngeal functions, especially after glossectomy. This review focuses on reconstructive methods after partial glossectomy, hemiglossectomy, and subtotal or total glossectomy and discusses current problems and the possibility of sensory and dynamic reconstruction.

“Five‐point eight‐line” anatomic flap design for precise hemitongue reconstruction

“…Precise anatomic replacement of the missing tongue seems an intuitive approach but has never been fully described in the literature. A review of literature suggests that previous reports of flap design were largely based on subjective estimation of the defects and contour . Precise measurements of the 3‐dimensional tongue anatomy and flap requirement have not been described.…”

“…A review of literature suggests that previous reports of flap design were largely based on subjective estimation of the defects and contour. 6,7,[12][13][14][15][16][17][18] Precise measurements of the 3-dimensional tongue anatomy and flap requirement have not been described. Such measurements are essential to guide flap design for a 3-dimensinal anatomic reconstruction of hemiglossectomy defects.…”

Functional Reconstruction of Glossectomy Defects: The Vertical Rectus Abdominus Myocutaneous Neotongue

“…Flaps employed for glossectomy defect reconstruction include the medial pterygoid, 15 infrahyoid, 16 sternocleido, 17 pectoralis major, [18][19][20] latissimus dorsi, 21,22 tensor fasciae latae, 23 forearm flap, [24][25][26] rectus abdominal, 7,8,[10][11][12] gracilis, 27 vastus lateralis, 28 lateral thigh flap, [29][30][31] anterolateral thigh flap, 32 and groin flap. 33 Despite these many options, the large defects arising from total/subtotal glossectomy mandate a large flap, which makes the VRAM a common choice.…”

“…Review of the literature revealed a consistent theme in the divergent approaches to achieve the common goal of improved functional reconstruction of the tongue. 12,34 Namely, maintenance of neotongue bulk and convexity yielded improved function. Recently, Yamamoto et al advocated hypoglossal to tenth intercostal nerve VRAM reconstruction to achieve a dynamic semifunctional tongue.…”

“…Although numerous local flaps and free flaps have been advocated as potential options for tongue reconstruction, the free vertical rectus abdominus myocutaneous (VRAM) flap has emerged as the workhorse flap for total or subtotal glossectomy defects. [7][8][9][10][11][12] The free VRAM flap is an effective space filler; it recontours the floor of the mouth, resurfaces the lingual aspect of the mandible, and provides stable, vascularized tissue that can withstand radiation therapy.…”