Free chimeric LD + SA flap for tongue and suprahyoid muscles reconstruction after total glossectomy.

BACKGROUND

This study aimed to report the functional outcomes of patients who underwent total or near total glossectomy for oral SCC reconstructed with a chimeric latissimus dorsi and serratus anterior (LD + SA) flap.

METHODS

Thirty-two patients with tongue cancer, with a mean age of 48.8 years, were included in the study. All patients underwent total or near total glossectomy and subsequent reconstruction with chimeric LD + SA flap. Swallowing and speech functions were measured and prospectively recorded pre- and 3,6 and 12 months postoperatively. Patient-reported outcomes were measured using the Speech Handicap Index (SHI), M.D. Anderson Dysphagia Inventory (MDADI), and EORTC-QLQ-H&N 35 score at 12 months. Additionally, volume reduction in the flaps was measured.

RESULTS

The mean follow-up period was 21 months (range, 2-67 months). The flaps were successfully placed in 30 cases. The total success rate was 93.8% (30/32). In 25 cases (83,3%), a positive functional outcome was recorded, defined as the achievement of an adequate swallowing and speech ability. The swallowing evaluation study revealed that 83% (25/30) of patients experienced bolus transit. Speech function was assessed 3, 6, and 12 months prospectively by speech therapist, with patient-reported SHI outcomes at 12 months. Speech intelligibility was good in 16,7% of cases (5/30, mean SHI 29.18, SD 16.36) acceptable in 56,7% (17/30, mean SHI 51.14, SD 19.8) and poor intelligibility in 26,7% (8/30, mean SHI 65.62 SD 9.8) at 12 months. Mean MDADI score was 84.5 (SD 12.15), indicating good swallowing function. Decannulation was possible in 25 of the 30 patients (83,3%).

CONCLUSION

The chimeric LD + SA free flap represents a feasible option for tongue reconstruction after salvage glossectomy, with promising functional outcomes and low donor-side morbidity. This approach significantly improved the patients' oral functions and quality of life.