Reinnervated Serratus Free Flap for a Functional Outcome in Tongue Reconstruction: A Surgical Technique Video

Abstract

The current benchmark for tongue reconstruction following the excision of locally advanced tumors involves the utilization of free skin or fasciocutaneous flaps, such as anterolateral thigh flap or forearm free flap. They facilitate the volumetric reconstruction of the tongue, leveraging passive mobility from the remaining native tongue tissue. The challenge in tongue reconstruction surgery persists in achieving functional restoration through adequate volume and optimized mobility, using tissue that is both adapted and comparable to native tissue. While the free serratus muscle flap has been described for various indications, its application in tongue reconstructions remains underexploited. Specifically, in cases of locally advanced tumors affecting the mobile tongue, typically within the junctional area and without extension to the floor of the mouth nor to the tip of the tongue, the serratus free flap has shown great results. Reinnervation of the flap is achieved connecting the thoracodorsal nerve to the descending branch of the XII nerve. This technique facilitates functional tongue reconstruction, promoting rapid mucosal epithelialization and reinnervation, which, in turn, preserves muscle volume and sustains adequate trophicity without fibrosis. Regarding these considerations, the pure muscle serratus free flap emerges as a valuable and effective alternative in tongue reconstruction. Notably, there is a dearth of step-by-step operative technique descriptions for this indication in the existing literature. We present a video demonstrating the surgical technique, showcasing procedures as performed at Tenon Hospital (Paris, France).