title: A new flap design for tongue reconstruction after total or subtotal glossectomy in thin patients.
abstract: OBJECTIVE
  For tongue reconstruction after total or subtotal glossectomy, a rectus abdominis musculocutaneous flap is often used to obtain sufficient flap volume. However, thin patients often have too little fat tissue to ensure adequate flap volume. For this reason we developed a new flap design to compensate for insufficient flap volume in thin patients.
  
  
  METHODS
  In this series, total or subtotal glossectomy was performed in 20 thin men with a mean age of 58.3 years. The patients had a mean body mass index of 18.22 kg/m(2) and most were considered emaciated. The defects were reconstructed using a rectus abdominis musculocutaneous flap with two skin islands. The first skin island was used to reconstruct the mucosal defect, and the second was de-epithelialised and used to increase flap volume.
  
  
  RESULTS
  Flaps were transferred successfully in 19 out of 20 patients. Most patients could tolerate more than a soft diet without severe aspiration and could engage in conversation. However, four patients required total laryngectomy or a permanent stoma owing to severe aspiration. In this series, the larynx could be preserved in 80% of thin patients, and satisfactory postoperative oral function was obtained.
  
  
  CONCLUSIONS
  The most important point for obtaining satisfactory oral function is to reconstruct a tongue with a protuberant shape and sufficient volume. We could maintain sufficient flap volume with the de-epithelialised skin island of a rectus abdominis musculocutaneous free flap. We believe our new flap design is effective for tongue reconstruction in thin patients.
authors.affiliation: Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Chiba 277-8577, Japan. msakurab@east.ncc.go.jp
authors.forename: Minoru
authors.initials: M
authors.lastname: Sakuraba
authors.forename: Takayuki
authors.initials: T
authors.lastname: Asano
authors.forename: Shimpei
authors.initials: S
authors.lastname: Miyamoto
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Hayashi
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Yamazaki
authors.forename: Masakazu
authors.initials: M
authors.lastname: Miyazaki
authors.forename: Toru
authors.initials: T
authors.lastname: Ugumori
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Daiko
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kimata
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005927:Glossectomy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013524:Surgical Flaps; D013851:Thinness / Q000150:complications*; D014059:Tongue / Q000473:pathology / Q000601:surgery*; D014062:Tongue Neoplasms / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome