A new flap design for tongue reconstruction after total or subtotal glossectomy in thin patients

Minoru Sakuraba, Takayuki Asano, Shimpei Miyamoto, Ryuichi Hayashi, Mitsuo Yamazaki, Masakazu Miyazaki, Toru Ugumori, Hiroyuki Daiko, Yoshihiro Kimata

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Objective: For tongue reconstruction after total or subtotal glossectomy, a rectus abdominis musculocutaneous flap is often used to obtain sufficient flap volume. However, thin patients often have too little fat tissue to ensure adequate flap volume. For this reason we developed a new flap design to compensate for insufficient flap volume in thin patients. Methods: In this series, total or subtotal glossectomy was performed in 20 thin men with a mean age of 58.3 years. The patients had a mean body mass index of 18.22 kg/m2 and most were considered emaciated. The defects were reconstructed using a rectus abdominis musculocutaneous flap with two skin islands. The first skin island was used to reconstruct the mucosal defect, and the second was de-epithelialised and used to increase flap volume. Results: Flaps were transferred successfully in 19 out of 20 patients. Most patients could tolerate more than a soft diet without severe aspiration and could engage in conversation. However, four patients required total laryngectomy or a permanent stoma owing to severe aspiration. In this series, the larynx could be preserved in 80% of thin patients, and satisfactory postoperative oral function was obtained. Conclusion: The most important point for obtaining satisfactory oral function is to reconstruct a tongue with a protuberant shape and sufficient volume. We could maintain sufficient flap volume with the de-epithelialised skin island of a rectus abdominis musculocutaneous free flap. We believe our new flap design is effective for tongue reconstruction in thin patients.

Original languageEnglish
Pages (from-to)795-799
Number of pages5
JournalJournal of Plastic, Reconstructive and Aesthetic Surgery
Volume62
Issue number6
DOIs
Publication statusPublished - Jun 2009

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Glossectomy
Tongue
Rectus Abdominis
Myocutaneous Flap
Skin
Laryngectomy
Free Tissue Flaps
Larynx
Body Mass Index
Fats
Diet

Keywords

  • Laryngeal preservation
  • Rectus abdominis musculocutaneous flap
  • Tongue reconstruction
  • Total glossectomy

ASJC Scopus subject areas

  • Surgery

Cite this

A new flap design for tongue reconstruction after total or subtotal glossectomy in thin patients. / Sakuraba, Minoru; Asano, Takayuki; Miyamoto, Shimpei; Hayashi, Ryuichi; Yamazaki, Mitsuo; Miyazaki, Masakazu; Ugumori, Toru; Daiko, Hiroyuki; Kimata, Yoshihiro.

In: Journal of Plastic, Reconstructive and Aesthetic Surgery, Vol. 62, No. 6, 06.2009, p. 795-799.

Research output: Contribution to journalArticle

Sakuraba, Minoru ; Asano, Takayuki ; Miyamoto, Shimpei ; Hayashi, Ryuichi ; Yamazaki, Mitsuo ; Miyazaki, Masakazu ; Ugumori, Toru ; Daiko, Hiroyuki ; Kimata, Yoshihiro. / A new flap design for tongue reconstruction after total or subtotal glossectomy in thin patients. In: Journal of Plastic, Reconstructive and Aesthetic Surgery. 2009 ; Vol. 62, No. 6. pp. 795-799.
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abstract = "Objective: For tongue reconstruction after total or subtotal glossectomy, a rectus abdominis musculocutaneous flap is often used to obtain sufficient flap volume. However, thin patients often have too little fat tissue to ensure adequate flap volume. For this reason we developed a new flap design to compensate for insufficient flap volume in thin patients. Methods: In this series, total or subtotal glossectomy was performed in 20 thin men with a mean age of 58.3 years. The patients had a mean body mass index of 18.22 kg/m2 and most were considered emaciated. The defects were reconstructed using a rectus abdominis musculocutaneous flap with two skin islands. The first skin island was used to reconstruct the mucosal defect, and the second was de-epithelialised and used to increase flap volume. Results: Flaps were transferred successfully in 19 out of 20 patients. Most patients could tolerate more than a soft diet without severe aspiration and could engage in conversation. However, four patients required total laryngectomy or a permanent stoma owing to severe aspiration. In this series, the larynx could be preserved in 80{\%} of thin patients, and satisfactory postoperative oral function was obtained. Conclusion: The most important point for obtaining satisfactory oral function is to reconstruct a tongue with a protuberant shape and sufficient volume. We could maintain sufficient flap volume with the de-epithelialised skin island of a rectus abdominis musculocutaneous free flap. We believe our new flap design is effective for tongue reconstruction in thin patients.",
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AU - Sakuraba, Minoru

AU - Asano, Takayuki

AU - Miyamoto, Shimpei

AU - Hayashi, Ryuichi

AU - Yamazaki, Mitsuo

AU - Miyazaki, Masakazu

AU - Ugumori, Toru

AU - Daiko, Hiroyuki

AU - Kimata, Yoshihiro

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N2 - Objective: For tongue reconstruction after total or subtotal glossectomy, a rectus abdominis musculocutaneous flap is often used to obtain sufficient flap volume. However, thin patients often have too little fat tissue to ensure adequate flap volume. For this reason we developed a new flap design to compensate for insufficient flap volume in thin patients. Methods: In this series, total or subtotal glossectomy was performed in 20 thin men with a mean age of 58.3 years. The patients had a mean body mass index of 18.22 kg/m2 and most were considered emaciated. The defects were reconstructed using a rectus abdominis musculocutaneous flap with two skin islands. The first skin island was used to reconstruct the mucosal defect, and the second was de-epithelialised and used to increase flap volume. Results: Flaps were transferred successfully in 19 out of 20 patients. Most patients could tolerate more than a soft diet without severe aspiration and could engage in conversation. However, four patients required total laryngectomy or a permanent stoma owing to severe aspiration. In this series, the larynx could be preserved in 80% of thin patients, and satisfactory postoperative oral function was obtained. Conclusion: The most important point for obtaining satisfactory oral function is to reconstruct a tongue with a protuberant shape and sufficient volume. We could maintain sufficient flap volume with the de-epithelialised skin island of a rectus abdominis musculocutaneous free flap. We believe our new flap design is effective for tongue reconstruction in thin patients.

AB - Objective: For tongue reconstruction after total or subtotal glossectomy, a rectus abdominis musculocutaneous flap is often used to obtain sufficient flap volume. However, thin patients often have too little fat tissue to ensure adequate flap volume. For this reason we developed a new flap design to compensate for insufficient flap volume in thin patients. Methods: In this series, total or subtotal glossectomy was performed in 20 thin men with a mean age of 58.3 years. The patients had a mean body mass index of 18.22 kg/m2 and most were considered emaciated. The defects were reconstructed using a rectus abdominis musculocutaneous flap with two skin islands. The first skin island was used to reconstruct the mucosal defect, and the second was de-epithelialised and used to increase flap volume. Results: Flaps were transferred successfully in 19 out of 20 patients. Most patients could tolerate more than a soft diet without severe aspiration and could engage in conversation. However, four patients required total laryngectomy or a permanent stoma owing to severe aspiration. In this series, the larynx could be preserved in 80% of thin patients, and satisfactory postoperative oral function was obtained. Conclusion: The most important point for obtaining satisfactory oral function is to reconstruct a tongue with a protuberant shape and sufficient volume. We could maintain sufficient flap volume with the de-epithelialised skin island of a rectus abdominis musculocutaneous free flap. We believe our new flap design is effective for tongue reconstruction in thin patients.

KW - Laryngeal preservation

KW - Rectus abdominis musculocutaneous flap

KW - Tongue reconstruction

KW - Total glossectomy

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