Management
The reinnervated serratus free flap, connected via the thoracodorsal nerve to the descending branch of the XII nerve, facilitates functional restoration, rapid mucosal epithelialization, and muscle reinnervation, preserving volume and trophicity [PMID:38563557].
This technique shows positive results specifically for cases involving the mobile tongue region, avoiding complications in areas like the floor of the mouth or tongue tip [PMID:38563557].
In a retrospective study comparing patients with early tongue cancer who underwent surgery with (group 1, n=56) and without (group 2, n=291) free flap reconstruction, group 1 achieved significantly larger mean free margins (7.88 mm vs 5.68 mm; p<.001) [PMID:30676880].
In a study of 11 cases, the lateral tongue flap demonstrated feasibility with only minor complications (1 flap tip necrosis, 2 hematomas) and preserved swallowing, speech, and tongue protrusion functions [PMID:10394173].
Complications
Among 11 patients undergoing lateral tongue flap reconstruction, complications included tip necrosis in one case and hematoma development in two cases [PMID:10394173].
Prognosis & Follow-up
By preserving muscle volume and sustaining adequate trophicity without promoting fibrosis, the reinnervated serratus flap may contribute to better long-term functional prognosis [PMID:38563557].
Despite a higher proportion of T2 stage patients in the free flap reconstruction group (group 1), this group exhibited a significantly lower recurrence rate (p=.024) [PMID:30676880].
Patients were rehabilitated to their preoperative functional status within 2 weeks post-reconstruction, indicating a quick recovery period [PMID:10394173].
Key Recommendations
The study concluded that free flap reconstruction not only achieved larger pathologic free margins but also correlated with lower recurrence rates and good survival outcomes in early stage tongue cancer patients [PMID:30676880]. (Evidence: Moderate)
References
1 Baujat B, Broustaut N, Dauzier E, Tassart M, Wagner I, Atallah S et al.. Reinnervated Serratus Free Flap for a Functional Outcome in Tongue Reconstruction: A Surgical Technique Video. Plastic and reconstructive surgery 2024. link 2 Lu CC, Tsou YA, Hua CH, Tsai MH. Free flap reconstruction for early stage tongue squamous cell carcinoma: surgical margin and recurrence. Acta oto-laryngologica 2018. link 3 Cunha-Gomes D, Joshi P, Bhathena H, Kavarana NM. The lateral tongue flap: a salvage option for reconstruction of buccal recurrences. Acta chirurgiae plasticae 1999. link