| Objective To evaluate the effectiveness of anterolateral thigh flap for tongue reconstruction,and investigate the impact of reinnervated and noninnervated flap reconstruction on patients’ sensory recovery,speech and swallow functions.The quality of life in tongue cancer patients was also assessed using UW-QOL.Methods 52 patients were classified into test group and control group.They all underwent tongue cancer resection and anterolateral thigh flap reconstruction.1.Tongue cancer resection:Different kinds of neck dissection were performed according to tongue cancer patients’ TNM stage.Facial artery,facial vein,superior thyroid artery and superior thyroid vein must be preserved.If the internal jugular vein must be resected,external jugular vein has to be preserved for vascular anastomosis.2.Preparation for anterolateral thigh flap: Draw a line from the outer border of the anterior superior iliac spine to the outer border of the patella as the first line.Then draw the second line from the middle point of the first line to the middle point of the inguinal ligament.The second line is just the surface projection of lateral circumflex femoral artery.The anterolateral thigh flaps were also designed with lateral femoral cutaneous nerve in test group.3.Reconstruction tissue defects: Suture the vascular of free flaps to cervical vascular in an end-to-end or end-to-side manner.The lateral femoral cutaneous nerve was sutured to the lingual nerve in test group.While in control group,patients were only received defects reconstruction after tumor resection.4.Function testing: The monitoring index after the surgery includes the appearance of color,swell and the graft patency using Doppler ultrasound.After the operation,we detected the sensory recovery and evaluated the speech and swallow functions.The QOL in patients were also assessed using UW-QOL.Results 1.There are patients 25 in test group and 27 patients in control group.51 flaps were transferred successfully.Flap failure occurred because of pedicle thrombosis in onpatient with innervated flap.Two patients had a small lymphatic leakage,which healed spontaneously after the debridement and wound dressing.2.Two patients were lost to follow-up after the surgery.Three patients died from tumor recurrence and one patient had tumor recurrence.Forty-six patients were included for function testing 6 months after the surgery.Speech scores were 4.13±0.68 for patients innervated group and 3.73±0.70 for noninnervated group(P>0.05).Swallow scores were 5.50±0.51 and 5.10±0.75 for the innervated group and noninnervated group,respectively(P=0.04).Four patients in noninnervated group had hot and cold sensation,while 21 patients in innervated group had hot and cold sensation;two patients in test group had pain sensation,while 20 patients had pain sensation in control group.Six month after the surgery,no patients with noninnervated flaps could feel the discriminator.Of 24 patients with innervated flaps,20 patients had 5.15mm±3.20 two-point discrimination after the operation.There was a significant improvement of sensory recovery after 6 months than 3 months.3.The overall QOL scores of the patients was 907.39.Shoulder,anxiety and pain domains had the highest scores,while chew,taste and speech domains had the lowest scores.The scores of activity,swallow and mood domains were higher in innervated group than noninnervated group.And the overall QOL was better in innervated group than noninnervated group.Conclusion Anterolateral thigh flap grafting is an acceptable technique for tongue reconstruction.Patients can had satisfactory and equivalent speech and swallow functions reconstructed both with innervated and noninnvervated flaps.Sensory recovery may improve swallow function,quality of life and overall patient satisfaction.With the efficacy of innervated anterolateral thigh flap being confirmed,it might become the conventional operation for tongue defects reconstruction in future. |
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