Fasciocutaneous flap reconstruction of the tongue and floor of mouth: outcomes and techniques.

OBJECTIVES To quantify functional and other outcomes after major resection and fasciocutaneous free-flap reconstruction of the tongue and floor of mouth, and to describe reconstructive technique. DESIGN A hypothesis-generating, retrospective cohort study of 43 patients who underwent, at minimum, a hemiglossectomy and resection of the floor of the mouth for oral cancer followed by fasciocutaneous free-flap reconstruction. SETTING A tertiary academic medical center in the midwestern United States. MAIN OUTCOME MEASURES Speech intelligibility, swallowing, interval to decannulation, length of stay, free-flap success rates, patient survival, and complications. RESULTS Thirty patients underwent oral tongue reconstructions, and 13, tongue base reconstructions. Median intelligibility scores were greater among patients in the tongue base group (98% intelligibility) than in the oral-tongue group (76% intelligibility) (P<.001). Of the 38 patients undergoing swallowing evaluation, 32 (85%) were able to feed entirely by mouth, most with mild to moderate dysphagia. All patients underwent decannulation (mean interval, 13.7 days). The mean length of hospital stay was 11 days, and free flaps in 42 patients (98%) survived. Twenty-eight patients (65%) were still alive by the end of the study, yielding a mean survival time of 27.4 months. Seven patients (16%) had severe medical and 3 (7%) had major surgical complications. CONCLUSION The folding techniques used in this study for reconstruction of the tongue with fasciocutaneous free flaps were associated with recovery of adequate speech and swallowing in most patients.