The anterolateral thigh flap for soft tissue reconstruction in patients with tongue squamous cell carcinoma

World Journal of Surgical Oncology, Aug 2016

Background Surgery remains the first choice of treatment for tongue cancer. Immediate reconstruction should be performed after wide resection of tumour. The aim of this study was to evaluate the anterolateral thigh flap for reconstruction of lingual defects. Methods We report 39 consecutive oral tongue squamous cell carcinoma patients who underwent lingual reconstruction with the anterolateral thigh flap between 2009 and 2010. Results The width of the skin island was 4 to 5 cm and the length of the skin island was 6 to 8 cm in 31 patients with T2 tumour, while the width of the skin island was 5.5 to 6 cm and the length of the skin island was 9 to 12 cm in 8 patients with T3/4 tumours. The all flap survival rate was 97.5 % in our series. Conclusions We could obtain sufficient flap volume using the anterolateral thigh flap for tongue reconstruction. The single perforator-based anterolateral thigh flap is a good option for soft tissue reconstruction in patients with oral tongue squamous cell carcinoma.

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The anterolateral thigh flap for soft tissue reconstruction in patients with tongue squamous cell carcinoma

Tong et al. World Journal of Surgical Oncology The anterolateral thigh flap for soft tissue reconstruction in patients with tongue squamous cell carcinoma Xiang-Juan Tong 0 Zhan-Gui Tang 0 2 Zhen-Feng Shan 1 Xin-Cheng Guo 3 0 Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University , Changsha, Hunan , China 1 Department of Head and Neck Surgery, Hunan Provincial Tumor Hospital, Affiliated Tumor Hospital of Xiangya Medical School, Central South University , Changsha, Hunan , China 2 Department of Oral and Maxillofacial Surgery, Xiangya Stomatological Hospital, Central South University , Changsha, Hunan , China 3 Department of Oral and Maxillofacial Surgery, Third Xiangya Hospital, Central South University , Changsha, Hunan , China Background: Surgery remains the first choice of treatment for tongue cancer. Immediate reconstruction should be performed after wide resection of tumour. The aim of this study was to evaluate the anterolateral thigh flap for reconstruction of lingual defects. Methods: We report 39 consecutive oral tongue squamous cell carcinoma patients who underwent lingual reconstruction with the anterolateral thigh flap between 2009 and 2010. Results: The width of the skin island was 4 to 5 cm and the length of the skin island was 6 to 8 cm in 31 patients with T2 tumour, while the width of the skin island was 5.5 to 6 cm and the length of the skin island was 9 to 12 cm in 8 patients with T3/4 tumours. The all flap survival rate was 97.5 % in our series. Conclusions: We could obtain sufficient flap volume using the anterolateral thigh flap for tongue reconstruction. The single perforator-based anterolateral thigh flap is a good option for soft tissue reconstruction in patients with oral tongue squamous cell carcinoma. Oral cancer; Tongue squamous cell carcinoma; Anterolateral thigh flap; Reconstruction Background Oral tongue squamous cell carcinoma (OTSCC) is the most common cancer diagnosed in the oral cavity comprising 25–40 % of oral carcinomas [ 1, 2 ], which demonstrates much more aggressive behaviour because of its unusual histologic makeup (rich lymphatic network and highly muscularized structure) [3]. OTSCC is thus more frequently associated with metastasis to draining lymph nodes than any other cancer of the oral cavity [ 4 ]. The major risk factor for OTSCC is chronic exposure of the oral mucosa to tobacco, alcohol and betel quid; they have a synergistic effect on carcinogenic development. Tongue submucous fibrosis and leukoplakia are also the most common premalignant lesions, and a betel quid chewing habit has usually been regarded as the main aetiology of submucous fibrosis [ 5, 6 ]. The reconstruction of a tongue defect is particularly challenging due to its comprehensive functions including articulation, deglutition and taste. Surgery remains the first choice of treatment for tongue cancer. Immediate reconstruction should be performed after wide resection of tumour [7]. The main aim is good function; aesthetic inside the mouth is secondary; and the main functions include articulation, deglutition and taste. Impairment of tongue function can severely affect quality of life. However, the restoration of the bulk, mobility and sensibility of the tongue also is one of the great challenges for surgeons. In the last 30 years, with the development of microsurgical reconstruction techniques, various free flaps have been described for extended lingual defect. In the last 20 years, the radial forearm flap has most commonly been used for reconstruction after hemiglossectomy. However, the radial forearm flap sacrifices a major artery at the donor site and leaves a cosmetically unfavourable scar. In the last 10 years, the anterolateral thigh (ALT) flap has come into popular use. The ALT flap can supply a large amount of soft tissue with the possibility of flap thinning and its long pedicle, and surgery can generally be performed in a two-team approach with a low donor site morbidity [ 8, 9 ]. Furthermore, complex tongue defects involving the tongue and the floor of the mouth require accurate multiplanar configuration of flap design and tailoring. The flap design is the key point in both preserving mobility and providing neotongue bulk. The purpose of this study was to describe the ALT flap supplied by a single perforator for soft tissue reconstruction in 39 cases with tongue cancer and to evaluate the survival characteristics of this flap. Methods Our study included 39 consecutive cases (30 males and 9 females) of biopsy-proved tongue squamous cell carcinoma and reconstructed by free ALT flap between 2009 and 2010 in our department (Fig. 1). The age groups ranged from 28 to 72 with a median age of 51. According to UICC classification (6th edition), there were 31 cases classified as T2, 3 as T3 and 5 as T4. The harvest of the flap, selection of the drainage vein and recipient vessel, microvascular anastomoses and postoperative management were perform (...truncated)


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Xiang-Juan Tong, Zhan-Gui Tang, Zhen-Feng Shan, Xin-Cheng Guo. The anterolateral thigh flap for soft tissue reconstruction in patients with tongue squamous cell carcinoma, World Journal of Surgical Oncology, 2016, pp. 213, 14, DOI: 10.1186/s12957-016-0972-8