Comparison of Functional and Survival Outcomes in Pedicled and Microsurgical Flap Reconstruction for Near-Total and Total Glossectomies

Elroy Saldanha; Dhruv G Patel; Sanjay M Desai; Vinod Dhakad; Bonny Joseph; Sandeep Ghosh; Ashma Monteiro

doi:10.4103/ams.ams_178_21

Comparison of Functional and Survival Outcomes in Pedicled and Microsurgical Flap Reconstruction for Near-Total and Total Glossectomies

Ann Maxillofac Surg. 2022 Jan-Jun;12(1):54-59. doi: 10.4103/ams.ams_178_21. Epub 2022 Aug 16.

Authors

Elroy Saldanha¹, Dhruv G Patel¹, Sanjay M Desai¹, Vinod Dhakad¹, Bonny Joseph¹, Sandeep Ghosh¹, Ashma Monteiro²

Affiliations

¹ Department of Surgical Oncology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India.
² Department of Statistics, Kasturba Medical College, Manipal, Karnataka, India.

Abstract

Introduction: Patients with advanced carcinoma tongue end up with near-total/total glossectomy (NTG/TG). We intended to compare functional, oncological, and survival outcomes of patients undergoing pedicled and microsurgical flap reconstruction in NTG/TG patients at our hospital.

Methodology: A prospective study was conducted for 7 years on 91 patients with carcinoma tongue who underwent NTG/TG at our institute. Patients underwent anterolateral thigh (ALT), free radial artery forearm flap (FRAFF), and pectoralis major myocutaneous (PMMC) flap reconstruction and were followed up for immediate complications and functional outcomes for speech, swallowing, and decannulation after completion of adjuvant treatment and then for survival rates for a period of 60 months and statistically analysed with log rank test and Fisher's exact test for correlation.

Results: Ninety-one (42.85%) patients underwent NTG, while 57.14% underwent TG. 85% of patients had >5 mm margin, 14% had ≤ of 5 mm, and none were positive. 57% of patients did not have postoperative complications and 10% underwent re-exploration. During follow-up, 85.7% of patients were able to take orally: 52% soft diet and 32% liquid diet. Multivariate analysis of individual flaps, swallowing, and speech intelligibility values were significant. After 5 years of postadjuvant therapy, there was 76% overall survival, 11% local recurrence and 12% had regional recurrence.

Discussion: Morbidity and functional outcome depends on the extent of resection. PMMC flaps can be done on lack of expertise. FRAFF has better functional outcomes owing to pliability of flap. ALT and other bulky flaps require expertise and are prone to flap-related complications. Planning of reconstruction should be based on the defect size together with counseling of patients regarding the risk of complications and delay in adjuvant therapy.

Keywords: Anterolateral thigh flap; free radial forearm flap; near-total and total glossectomies; pectoralis major myocutaneous flap; speech intelligibility.