[Free anterolateral thigh myocutaneous flap for reconstruction of soft tissue defects following en block resection of tongue cancer].

OBJECTIVE: To evaluate the results of the reconstruction of the soft tissue defects following the en block resection of tongue cancer using free anterolateral thigh myocutaneous flaps.

METHODS: From November 2006 to December 2008, 109 cases underwent the reconstruction of the soft tissue defects following the en block resection of tongue cancer using free anterolateral thigh myocutaneous flaps. There were 75 males and 34 females with an age of 23-75 years (50.4 years on average). The disease course was 1-6 months. According to 2002 International Union Control Cancer (IUCC) criterion for TNM stage, there were 35 cases of T2N0M0, 8 cases of T2N1M0, 2 cases of T2N2M0, 31 cases of T3N0M0, 12 cases of T3N1M0, 7 cases of T3N2M0, 5 cases of T4N0M0, 4 cases of T4N1M0, 3 cases of T4N2M0, and 2 cases of T4N3M0. The range of tongue defect was 5 cm x 3 cm to 12 cm x 8 cm. The flap area ranged from 7 cm x 4 cm to 20 cm x 8 cm. Eighty-two patients with T3, T4 and positive lymph node metastasis determined by pathological examination after operation received radiotherapy. The vitality of the flaps and the healing of the wounds were observed postoperatively. The shape and function of the reconstructed tongue were determined, the influences on function at donor site were evaluated and the flap tolerance to radiotherapy was investigated during the follow-up period.

RESULTS: Mouth floor mandibular fistula occurred in 5 cases 5-7 days after operation, seroma formation in 1 case and wound dehiscence in another case at the donor site; the wounds healed by secondary intention after dressing. The other wounds healed primarily. All 105 flaps survived completely, 3 flaps developed partial necrosis 3-5 days after operation, the wounds healed after dressing; and 1 flap failed 3 days after operation, then it was removed and defects was repaired using pectoralis major muscle flap. Blisters occurred in 8 flaps (all being thinning flaps) 1 day after operation. The overall complete survival of the flap was 96.3% (105/109). The patients were followed up for 0.5-2.5 years (1.2 years on average). Although the flaps had a little atrophy, the shape of the reconstructed tongue was still satisfactory with suitable tongue-mandibular groove. No depression was observed in the mandibular region. The speech as well as swallowing function were well recovered. The scar was easily hidden with no important functional impairment at the donor site. No flap necrosis occurred in all the patients who received postoperative radiotherapy.

CONCLUSION: Free anterolateral thigh myocutaneous flap transplantation is safe and reliable, and it has the advantages of the better result at the recipient site, the less morbidity at the donor site, fewer postoperative complications and excellent tolerance to radiotherapy. So it is an ideal flap to repair soft tissue defects following the en block resection of tongue cancer.