Perforator Branch-based Dissection for Ultrathin Anterolateral Thigh Free Flap for Tongue Reconstruction: A Preliminary Report.

BACKGROUND

This study compared tongue reconstructions in hemiglossectomy patients using ultrathin free flaps with perforator branch-based dissection (PBD) versus conventional anterolateral thigh (ALT) subfascial free flaps. We aimed to evaluate the success rates and speech function outcomes of these techniques, focusing on managing flap thickness.

METHODS

A retrospective review of hemiglossectomy patients (2017-2023) was conducted, focusing on ultrathin subdermal perforator free flaps versus conventional ALT free flaps. Speech function, surgical details, and complications were assessed to compare outcomes. Speech intelligibility and articulation were analyzed using standardized tests.

RESULTS

Sixteen patients (mean age 49 [range 22-81] y) underwent tongue reconstruction with conventional or PBD ALT flaps. The PBD flap group had no debulking needs, whereas 3 conventional flap patients required it. Speech function analysis showed higher articulation (89.5% versus 80.5%) and intelligibility (100% versus 84.3%) in the PBD flap group.

CONCLUSIONS

PBD for ultrathin ALT flaps in hemiglossectomy patients offers comparable functional outcomes to conventional ALT flaps, making PBD a viable alternative, despite the learning curve.