Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Mar;129(4):681-690.
doi: 10.1002/jso.27560. Epub 2023 Dec 10.

Clinical, functional, and patient-reported outcomes of radial forearm versus anterolateral thigh free tissue transfer for reconstruction of glossectomy defects

Kevin K Zhang  1 , Francis D Graziano  1 , Zack Cohen  1 , Louise Cunningham  2 , Barkat Ali  1 , Janet Coleman-Belin  1 , Minji Kim  1 , Kathryn Haglich  1 , Jennifer R Cracchiolo  3 , Evan Matros  1 , Farooq Shahzad  1 , Jonas A Nelson  1 , Robert J Allen Jr  1
Affiliations

Clinical, functional, and patient-reported outcomes of radial forearm versus anterolateral thigh free tissue transfer for reconstruction of glossectomy defects

Kevin K Zhang et al. J Surg Oncol. 2024 Mar.

Abstract

Background: There is a lack of literature of health-related quality of life endpoints for radial forearm (RF) versus anterolateral thigh (ALT) free flap reconstruction for glossectomy defects. Our goal was to perform a comprehensive evaluation of clinical, functional, and quality of life outcomes after glossectomy reconstruction using a RF or ALT flap.

Methods: A retrospective review was performed on patients who underwent glossectomy and immediate reconstruction with RF or ALT flaps between 2016 and 2021. Outcomes of interest included readmission and reoperation rates, functional assessments, tracheostomy and gastrostomy tube status, and FACE-Q Head and Neck Cancer scores.

Results: Seventy-eight patients consisting of 54 RF and 24 ALT free flaps were included. ALT patients had a larger median flap size (72 vs. 48 cm2 , p = 0.021) and underwent mandibulotomy (50% vs. 7.4%, p < 0.0001) and base of tongue resection (58.3% vs. 24.1%, p = 0.005) at higher rates. No significant differences were found with respect to other outcomes.

Conclusion: The RF and ALT flaps are suitable for glossectomy reconstruction, with minimal differences seen in postoperative outcomes. Our study suggests that ALT can be used in patients with base of tongue and larger defect sizes, while providing similar functional and clinical outcomes to RF reconstruction.

Keywords: ALT; FACE-Q; free flap; glossectomy; health-related quality of life (HRQOL); radial forearm.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
151 immediate glossectomy reconstructions were evaluated for this study. 37 were excluded because the patient did not undergo a speech language pathology evaluation, 10 patients were excluded for total glossectomy, and 26 patients were excluded for having underwent a concurrent mandibulectomy. The final study cohort included 78 patients composed of 54 radial forearm flaps and 24 ALT flaps.
Figure 2.
Figure 2.
Most patients experienced a degree of disability in lingual strength after reconstruction. The distribution of outcomes was comparable between cohorts.
Figure 3.
Figure 3.
Most patients experienced a degree of disability in lingual range of motion after reconstruction. The distribution of outcomes was comparable between cohorts.
Figure 4.
Figure 4.
Most patients maintained normal voice quality. The radial forearm cohort had a greater percentage of patients graded as normal, but this difference was not significant.
Figure 5.
Figure 5.
A significantly greater proportion of ALT patients required a PEG tube at the 30-day timepoint. ALT patients also were more like to require a PEG tube at subsequent timepoints, but this difference did not reach significance.
Figure 6.
Figure 6.
The proportion of patients who required a tracheostomy tube was highest at the 30-day timepoint and was comparable between groups at all timepoints.
Figure 7.
Figure 7.
One-year postoperative results for hemiglossectomy reconstruction with a (left) radial forearm free flap and (right) an ALT free flap. The aesthetic outcome for both patients is good.
See this image and copyright information in PMC

References

    1. Ji YB, Cho YH, Song CM, Kim YH, Kim JT, Ahn HC, Tae K. Long-term functional outcomes after resection of tongue cancer: determining the optimal reconstruction method. Eur Arch Otorhinolaryngol. Oct 2017;274(10):3751–3756. doi:10.1007/s00405-017-4683-8 - DOI - PubMed
    1. Hsiao HT, Leu YS, Chang SH, Lee JT. Swallowing function in patients who underwent hemiglossectomy: comparison of primary closure and free radial forearm flap reconstruction with videofluoroscopy. Ann Plast Surg. May 2003;50(5):450–5. doi:10.1097/01.Sap.0000044147.09310.E8 - DOI - PubMed
    1. Hsiao HT, Leu YS, Lin CC. Primary closure versus radial forearm flap reconstruction after hemiglossectomy: functional assessment of swallowing and speech. Ann Plast Surg. Dec 2002;49(6):612–6. doi:10.1097/00000637-200212000-00010 - DOI - PubMed
    1. Vincent A, Kohlert S, Lee TS, Inman J, Ducic Y. Free-Flap Reconstruction of the Tongue. Semin Plast Surg. Feb 2019;33(1):38–45. doi:10.1055/s-0039-1677789 - DOI - PMC - PubMed
    1. Bokhari WA, Wang SJ. Tongue reconstruction: recent advances. Curr Opin Otolaryngol Head Neck Surg. Aug 2007;15(4):202–7. doi:10.1097/MOO.0b013e3281fbd406 - DOI - PubMed

LinkOut - more resources