"Five-point eight-line" anatomic flap design for precise hemitongue reconstruction

Abstract

Background: Reconstruction of hemiglossectomy defects requires careful flap design to avoid adverse functional and aesthetic outcomes.

Methods: Hemitongue specimens were obtained from minipigs to study the three-dimensional anatomy and to define anatomic landmarks for precise measurements of flap requirement. The concept developed in animal models was then applied to hemiglossectomy reconstruction in clinical practice. Sixty-one patients were randomly enrolled into the following two groups: a "five-point eight-line segment" (FIPELS) flap design group (28 patients) and a conventional group (33 patients). Functional and aesthetic outcomes were compared between the two groups.

Results: All flaps designed with the FIPELS technique matched the hemiglossectomy defects without the need for flap trimming, thus reducing the operating time (P = .03). Swallowing functions, speech intelligibility, and aesthetic outcomes were superior in the FIPELS group than that in the conventional group (P < .05).

Conclusions: The FIPELS flap design for hemiglossectomy reconstruction yields improved functional and aesthetic outcomes compared to a conventional flap design.

Keywords: anterolateral thigh flap; five-point eight-line segment flap design; kissing radial forearm flap; sensory reinnervation; tongue reconstruction.