Total Tongue Reconstruction with Free Rectus Abdominis Myocutaneous Flaps: Functional Results

Advanced tongue cancer demands extremely extensive resection (radical pelvi-glossectomy) that must be followed by functional reconstruction to restore swallowing, speaking, and epyglottal competence. Between March 1999 and March 2005, ten total tongue reconstructions were performed by the authors after T4 tongue cancer resections (radical pelvi-glossectomy + bilateral lymphectomy) with the vertical myocutaneus rectus abdominis free flap (VRAM flap). The flap was not re-innervated.

The oral floor was reconstructed with the muscular part of the flap, fixing the aponeurosis anteriorly to the mandibular bone and posteriorly to the hyoid bone to obtain a complete palatal occlusion of the new tongue against the hard palate. The tongue was reconstructed by shaping the skin to obtain maximum thickness in its anterior portion. The donor site was always repaired with a prosthetic mesh.

The average follow-up was 18 months. No flap loss or partial necrosis occurred; all patients showed valid swallowing and intelligible speech at 6 months postoperatively.