Experience of application of binevral ALT-flap for tongue reconstruction

Abstract

The purpose of this study was to share our clinical experience of using a new technique for tongue reconstruction after hemi-, subtotal and total resection with a bineural musculocutaneous anterolateral thigh flap (ALT).Material and Methods. During the period from 2020 to 2021 four patients were diagnosed with oral cavity cancer and underwent radical surgical treatment with cervical lymphadenectomy and simultaneous tongue reconstruction using binerval ALT flap, with the performance of neural anastomoses of the sensitive branch to the great auricular nerve, and the motor branch to the accessory branch of the hypoglossal nerve.Results. All patients were aged 36 to 64 years.. Squamous cell carcinoma was diagnosed in all cases. Disease stages according to TNM were from II to IVa. Tracheostomy was performed in 3 out of 4 cases. The duration of hospital stay varied from 14 to 27 days. The development of postoperative complications was not observed. Oral meals were started on average 3 weeks after surgery. Decanulation in 3-4 weeks after surgery. Speech intelligibility was assessed on a scale, in 3 patients it was rated as good (4), in 1 patient it was poor (2). Swallowing score on a scale, 7 points in 2 patients, 6 points in 1 patient, 4 points in 1 patient. All sensory tests were satisfactory in all cases. No recurrence was observed.Conclusion. The ALT flap gained its popularity in tongue reconstruction due to a long and reliable vascular pedicle, the ability to vary the amount of tissue required to replace various defects, both in hemiglossectomy and in total glossectomy and low donor site morbidity. Also the flap has the advantages of double reinnervation, which ensures its functionality.