COMPARATIVE ANALYSIS OF THE OUTCOMES OF REPLACEMENT OF HEMI-TONGUE DEFECTS IN CANCER PATIENTS WITH THE USE OF VARIOUS RECONSTRUCTIVE APPROACHES
Keywords:
hemi-tongue defect, submental flap, radial free forearm autotransplant, supraclavicular artery flap.Abstract
Summary. Objective: to compare the outcomes of plastic replacement of hemi-tongue defects with the use of
regional submental, supraclavicular artery flaps and
radial free forearm autotransplant. Object and methods: the study included 38 patients with cancer of the
tongue and the oral mucosa, stages III–IV, who underwent hemiresection and cervical lymphodissection. The
patients were divided into three groups, depending on
the type of reconstructive technique used to replace the
hemi-tongue defect. The first group consisted of 11 patients, who had the defects replaced with the regional
supraclavicular artery flap. The second group included
12 patients, who were used a radial free forearm autotransplant to replace the defect. The third group comprised 15 patients, who had the defects eliminated by
a regional submental flap. There were compared the
values as follows: the duration of surgical intervention
and inpatient treatment, the complications after the
transplantation of flaps, postoperative complications
and complications in the donor site, functional status
and patients’ quality of life. Results: the mean duration
of surgery in patients of group II was 9.60 ± 0.40 hours
versus 5.36 ± 0.18 hours in patients of group I and
5.63 ± 0.27 hours in group III (p < 0.05). The frequency of complications in the donor site in patients of
group II was 49.9% versus 9.1% in patients of group I
and 6.7% in group III (p = 0.01). There were no statistically significant differences in duration of inpatient
treatment (p = 0.17), the frequency of complications after the transplantation of flaps (p = 0.59), the frequency of postoperative complications (p = 0.94), functional
status (p > 0.05), or quality of life (p > 0.05) between
the groups. The use of a radial free forearm autotransplant is associated (p = 0.03) with an increased risk of
complications in the donor site (odds ratio = 14; 95%
confidence interval 1.4–143) as compared with the use
of submental and supraclavicular arteries flaps. Conclusions: the use of regional submental and supraclavicular artery flaps significantly reduces the duration of
surgical intervention and the frequency of complications
in the donor site as compared with radial free forearm
autotransplants. There were no statistically significant
differences in the duration of inpatient treatment, the
frequency of necrosis after the transplantation of flaps,
postoperative complications, functional status, or patients’ quality of life between the groups
References
Lam L, Samman N. Speech and swallowing following tongue cancer surgery and free flap reconstruction — A systematic review. Oral Oncol 2013; 49 (6): 507–24.
Lee DY, Ryu YJ, Hah JH, et al. Long-term subjective function after partial glossectomy. J Oral Rehabil 2014; 41 (10): 754–8.
Ji Y, Cho YH, Song CM, et al. Long-term functional outcomes after resection of tongue cancer: determining the optimal reconstruction method. Eur Arch Otolaryngol 2017; 274 (10): 3751–6.
Tarsitano A, Vietti MV, Cipriani P, et al. Functional results of microvascular reconstruction after hemiglossectomy: free anterolateral thigh flap versus free forearm flap. Acta Otorhinolaryngol Ital 2013; 33: 374–9.
Herr MW, Emerick KS, Deschler DG et al. The supraclavicular artery flap for head and neck reconstruction. JAMA Facial
Plast Surg 2014; 16 (2): 127–32.
Howard BE, Nagel TH, Donald CB, et al. Oncologic safety of the submental flap for reconstruction in oral cavity malignancies. Otolaryngol Head Neck Surg 2014; 150 (4): 558–62.
Patel UA, Hartig GK, Hanasono MM, et al. Locoregional flaps for oral cavity reconstruction: a review of modern options. Otolaryngol — Head Neck Surg 2017; 157 (2): 201–7.
Paydarfar JA, Patel UA. Submental island pedicled flap vs radial forearm free flap for oral reconstruction: Comparison of outcomes. Arch Otolaryngol Head Neck Surg 2011; 137 (1): 82–7.
Forner D, Phillips T, Rigby M, et al. Submental island flap reconstruction reduces cost in oral cancer reconstruction compared to radial forearm free flap reconstruction: a case series and cost analysis. J Otolaryngol Head Neck Surg 2016; 45: 11.
Barton BM, Riley CA, Pou JD, et al. The submental island
flap is a viable reconstructive option for a variety of head and neck ablative defects. Ochsner J 2018; 18: 53–8.
Kokot N, Mazhar K, Reder LS, et al. The supraclavicular artery island flap in head and neck reconstruction: applications and limitations. JAMA Otorhinolaryng — Head Neck Surg 2013; 139 (11): 1247–55.
Padiyar BV, Mohiyuddin SM, Sagayaraj A, et al. Usefulness of supraclavicular flap in reconstruction following resection of oral cancer. World J Otorhinolaryng — Head Neck Surg 2018; 4: 148–52.
Giordano L, Di Santo D, Occhini A, et al. Supraclavicular artery island flap (SCAIF): a rising opportunity for head and neck reconstruction. Eur Arch Otorhinolaryng 2016; 273 (12): 4403–12.
Welz C, Canis M, Schwenk-Zieger S, et al. Oral cancer reconstruction using the supraclavicular artery island flap: comparison to free radial forearm flap. J Oral Maxillofac Surg 2017; 75 (10): 2261–9.
Rogers SN. Improving quality-of-life questionnaires in head and neck cancer. Exp Rev of Quality of Life in Cancer Care 2016; 1 (1): 61–71.
Petrie A, Sabin C. Medical Statistics at a Glance (3rd ed.). Chichester, UK: Wiley-Blakwell, 2009. 180 p.
Kozin ED, Sethi RK, Herr M, et al. Comparison of perioperative outcomes between the supraclavicular artery island flap and fasciocutaneous free flap. Otorhinolaryng Head Neck Surg 2016; 154 (1): 66–72.
Yun TK, Yoon ES, Ahn DS, et al. Stabilizing morbidity and predicting the aesthetic results of radial forearm free flap donor sites. Arch Plast Surg 2015; 42: 769–75.
