title: The mushroom-shaped anterolateral thigh perforator flap for subtotal tongue reconstruction.
abstract: BACKGROUND
  Reconstruction of a functional tongue with proper motility and sensation after subtotal resection is a demanding procedure. The authors describe the reinnervated mushroom-shaped anterolateral thigh perforator flap for subtotal tongue reconstruction.
  
  
  METHODS
  Thirteen patients (mean age, 54.8 years; range, 49 to 71 years) diagnosed with T3 and T4 squamous cell carcinomas were allocated prospectively to anterior total mobile (n = 7) or subtotal tongue resection (n = 6). All patients received the mushroom-shaped anterolateral thigh perforator flap. A Likert scale ranging from 1 to 4 was used to assess speech intelligibility, swallowing function, and cosmetic results. Epicritic and proprioceptive sensitivity testing was performed with the Pressure-Specified Sensory Device on the tip of the tongue preoperatively, on the neotongue at the donor site preoperatively, and at the recipient site 12 months postoperatively; protopathic thermoreceptor and nociceptors were clinically investigated. Outcomes were analyzed, and values of p < 0.05 were considered significant.
  
  
  RESULTS
  All flaps healed uneventfully (mean follow-up, 18 months). Six patients (46.2 percent) recovered a nearly natural deglutition, whereas seven (53.8 percent) had mild impairment (p = 0.274). Normal intelligible speech was achieved in seven cases (53.8 percent), and acceptable intelligible speech was achieved in six (46.2 percent) (p = 0.286). Aesthetic results were excellent in eight patients (61.5 percent) and good in five (38.5 percent) (p = 0.592). All patients recovered epicritic, proprioceptive, and protopathic sensitivity; cortical upgrading phenomena of the recipient nerve were observed.
  
  
  CONCLUSIONS
  The reinnervated mushroom-shaped anterolateral thigh perforator flap was found to be an innovative and effective option for subtotal tongue reconstruction.
authors.affiliation: Rome, Italy From the Plastic Surgery Unit and the Maxillofacial Surgery Unit, Sant'Andrea Hospital, School of Medicine and Psychology, Sapienza University of Rome.
authors.forename: Benedetto
authors.initials: B
authors.lastname: Longo
authors.forename: Marco
authors.initials: M
authors.lastname: Pagnoni
authors.forename: Germano
authors.initials: G
authors.lastname: Ferri
authors.forename: Roberto
authors.initials: R
authors.lastname: Morello
authors.forename: Fabio
authors.initials: F
authors.lastname: Santanelli
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005927:Glossectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D061525:Perforator Flap / Q000294:innervation / Q000637:transplantation*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D013848:Thigh; D014059:Tongue / Q000294:innervation / Q000601:surgery*; D014062:Tongue Neoplasms / Q000601:surgery*; D016896:Treatment Outcome