Beavertail modification of the radial forearm free flap in total oral glossectomy reconstruction: Technique and functional outcomes

• Published in: Oral oncology 2019-09, Vol.96, p.71-76
• Main Authors: Dziegielewski, Peter T., Rieger, Jana, Shama, Mohamed A., O'Connell, Daniel A., Harris, Jeffrey R., Seikaly, Hadi
• Format: Article
• Language: English
• Subjects: Functional outcomes; Head and neck cancer; Radial forearm free flap; Tongue reconstruction; Total oral glossectomy
• ISSN: 1368-8375; 1879-0593
• DOI: 10.1016/j.oraloncology.2019.07.004

•Beavertail modified radial forearm free flap (BTRFFF) can reconstruct a total oral tongue.•Long term swallowing and speech functions are excellent.•Quality of life is maintained at a high level reported by patients. The total oral tongue (anterior 2/3 glossectomy) defect is seldom addressed in the literature. This is the first series to describe a consistent technique for its reconstruction. The aim of the study is to describe the use of the beavertail modified radial forearm free flap (BTRFFF) to reconstruct a total oral tongue defect and the functional and quality of life outcomes associated with it. Retrospective review of prospectively collected data from 2000 to 2010. All patients at the University of Alberta undergoing head and neck free flap surgery are enrolled in a prospective functional outcomes program. Pre-operatively and at set post-operative time points patients complete videofluoroscopic swallowing studies (VFSS), speech evaluations and quality of life questionnaires (EORTC H&N-35). Peri-operative outcomes were also measured. 17 consecutive patients were included. All were gastrostomy tube free at 12 months post-operatively and tolerating a full soft diet with aspiration scores of 0. Swallowing transit times increased by a mean of 0.4 s (p = 0.32). Speech intelligibility remained high with mean sentence intelligibility at 75% and single word intelligibility at 62%. Quality of life scores returned to baseline and remained satisfactory. Complications related to the BTRFFF were limited to scarring. The BTRFFF provides a robust reconstructive option for the total oral tongue defect with excellent long term functional outcomes and quality of life.