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)