Tongue reconstruction with a free two-island rectus abdominis musculocutaneous flap after subtotal or total glossectomy

Postoperative oral functions after subtotal or total glossectomy are closely related to the shape of the reconstructed tongue. Although wider and thicker flaps are recommended to ensure that the reconstructed tongue has a protuberant shape, obtaining flaps of sufficient volume in thin patients is difficult. Therefore, a new flap design should be considered for such patients. In this article we report our experiences with tongue reconstruction after subtotal or total glossectomy in thin patients. From 1997 through 2002, 11 thin patients (mean body mass index, 18.1 kg/m2) underwent subtotal or total glossectomy followed by immediate microsurgical reconstruction. The protuberant shape of the reconstructed tongue was created with a free two-island rectus abdominis musculocutaneous flap. The first skin island is used to reconstruct the surface of the tongue, and the second skin island is de-epithelized and inserted beneath the first to obtain a protuberant shape. Although flaps were transferred successfully in all 11 patients (mean skin island thickness. 6 mm), the larynx could not be preserved in 3 patients owing to aspiration pneumonia. After reconstruction, most patients could tolerate more than a soft diet and could engage in conversation. Our method is simple, less invasive than other methods, and useful for reconstructing defects after ablation of large tongue tumors in thin patients. However, patients in whom laryngeal preservation is possible after subtotal or total glossectomy must be chosen carefully.