title: Bilobed perforator free flaps for combined hemitongue and floor-of-the-mouth defects.
abstract: BACKGROUND
  Combined hemiglossectomy and floor-of-the-mouth defects need accurate reconstructive planning to restore swallowing and speech function. The aim of this prospective study was to evaluate outcomes of the bilobed design applied to perforator free flaps for combined hemitongue and floor-of-the-mouth defects.
  
  
  METHODS
  Twelve patients with a mean age of 71 years (range, 60-84) addressed to combined hemiglossectomy and floor-of-the-mouth resection and bilobed-shaped perforator free-flap reconstruction were prospectively enrolled. Defects were classified as follows: type 1, including only the anterior mobile portion of the tongue (n = 3); type 2, involving both mobile tongue and tongue base (n = 6); and type 3, including segmental mandibulectomy combined with a type 1 or type 2 defect (n = 3). The Kruskal-Wallis and Bonferroni post hoc tests were used to compare outcomes.
  
  
  RESULTS
  Type 1 defects were reconstructed by three anterolateral thigh (ALT) perforator flaps; type 2 defects were reconstructed by four ALT flaps and two vertical deep inferior epigastric perforator flaps; and type 3 defects were restored by three osteocutaneous fibula flaps. Eleven flaps (91.6%) healed uneventfully, while one (8.4%) suffered a small area of skin necrosis whose revision did not compromise functional results. Six patients achieved normal intelligible speech, five had acceptable intelligible speech and one had unintelligible speech (p = 0.356). Swallowing function was considered normal in eight patients and with mild impairment in four (p = 0.178). Cosmesis resulted excellent in seven patients and good in five (p = 0.855).
  
  
  CONCLUSIONS
  The bilobed-shaped perforator free flaps were shown to be a safe and predictable solution for combined hemitongue and floor-of-the-mouth defects providing optimal aesthetic and functional outcomes.
authors.affiliation: Plastic Surgery Unit, Sant'Andrea Hospital, NESMOS Department, School of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Longo
authors.forename: G
authors.initials: G
authors.lastname: Ferri
authors.forename: A
authors.initials: A
authors.lastname: Fiorillo
authors.forename: C
authors.initials: C
authors.lastname: Rubino
authors.forename: F
authors.initials: F
authors.lastname: Santanelli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003679:Deglutition; D005260:Female; D058752:Free Tissue Flaps / Q000009:adverse effects; D005927:Glossectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009060:Mouth Floor / Q000601:surgery*; D009062:Mouth Neoplasms / Q000601:surgery*; D009336:Necrosis / Q000209:etiology; D061525:Perforator Flap / Q000009:adverse effects; D012867:Skin / Q000473:pathology; D013060:Speech; D013848:Thigh / Q000601:surgery; D014059:Tongue / Q000601:surgery*
keywords: ALT flap; Bilobed flaps; Hemiglossectomy; Oral cavity reconstruction; Perforator flaps; Tongue reconstruction; VDIEP flap