Vein preservation strategies to improve the survival rate of the infrahyoid musculocutaneous flap.

The infrahyoid musculocutaneous flap (IHMCF) is a good alternative in the reconstruction of moderate-sized oral cavity surgical defects. Insufficient venous drainage can significantly affect the survival rate of this flap. OBJECTIVES: Identify the survival rates of the IHMCF and evaluate the functional capacity of reconstructed patients. DESIGN: We report a case series. SETTING: This study took place at the Department of Head and Neck Surgery of Oncology Hospital Ho Chi Minh City, the largest oncology center in South Vietnam. PARTICIPANTS: One hundred and twelve patients with surgical defects after oral cavity resection for cancer underwent IHMCF reconstruction from November 2013 to November 2018. During the harvest of the flap, our modification of the surgical technique specifically attempted to preserve more secondary veins for IHMCF. MAIN OUTCOME MEASURES: Postoperative viability of the flap was checked by clinical observation. The last examination was performed at 3-months after reconstructive operation or after the completion of adjuvant radiotherapy. The functional capacity of our patients was evaluated by three physicians (Head and Neck Surgeon, Radiation Oncologist, and Physiatrist) with understandability of speech scale and the functional oral intake score items assessed. RESULTS: Two cases of partial skin necrosis (1.8%) were experienced. The majority of patients demonstrated favorable functional rehabilitation at long-term follow up. CONCLUSIONS: The IHMCF is a reliable flap suitable for moderate-sized defects of the oral cavity. Altering the surgical approach to specifically preserve more venous outflow can improve the survival rate of the flap. LEVEL OF EVIDENCE: 4.

Progressive functional improvement in hemiglossectomy defects reconstructed with radial forearm free flap at 6-months.

OBJECTIVE: The purposes of the study was to evaluate for the functional improvement of outcomes of patients undergoing surgical management for tongue cancer at varying periods after surgery. DESIGN: Case series with intervention. PARTICIPANTS: Thirty consecutive patients, from 2011 to 2015, with carcinoma of the tongue undergoing surgical resection and reconstruction with a radial forearm free flap. MAIN MEASURES: The Speech Intelligibility Test (SIT) is used for objective evaluation of speech function. The 7-point ordinal scale Functional Oral Intake Score (FOIS) was used to estimate the swallowing function. RESULTS: The patients included were 25 men and 5 women with a mean age of 50.4 years (range - 27-65). All tumors were squamous cell carcinomas and all patients underwent a hemiglossectomy. There were two complete flap failures, with a resultant flap success rate of 93.3%. The initial mean speech intelligibility scores at 1-month increased from 72.3 ±â€¯0.2 to 77.7 ±â€¯8.9 at 6-months after surgery (p = 0.05). Similarly, the mean score of swallowing function improved from 6.1 at 1-month to 6.8 at 6-months after surgery (p = 0.05). CONCLUSION: Reconstruction of hemiglossectomy defects with a radial forearm free flap offers functional benefits in speech and deglutition that demonstrate progressive improvement when 1- and 6-month post-surgical assessments are compared.