title: Long-term functional outcomes after total tongue reconstruction: Consideration of flap types, volume, and functional results.
abstract: OBJECTIVE
  The purpose of this study is to evaluate the long-term results of flap volume change, swallowing capacity, speech intelligibility, and differences between vertical rectus musculocutaneous (VRAM) and anterolateral musculocutaneous (ALT) free flaps in total tongue reconstruction.
  
  
  METHODS
  We retrospectively analyzed the medical records of 31 patients who underwent total tongue reconstruction with VRAM (24 cases) and ALT flap (7 cases). The mean age of patients was 52.09 ± 2.25 years. The tumor types were as follows: squamous cell carcinoma (28 cases), adenoid cystic carcinoma (2 cases), and metastatic cancer (1 case). The flap volume was determined based on clinical and imaging examinations. Swallowing and speech function were analyzed using seven-point rating scales.
  
  
  RESULTS
  All flaps survived eventually after surgery; however, 1 patient underwent VRAM flap experienced partial flap necrosis, wound dehiscence in 4 patients underwent VRAM flap, and infection in 3 patients (VRAM; 2 patients, ALT; 1 patient). The mean follow-up period was 3.97 ± 0.54 years. The volume of the flaps remained relatively constant over time. The swallowing capacity positively correlated with the flap volume (P < 0.0001); however, the speech intelligibility did not correlate with the flap volume in analysis of total cohort. There were no statistical differences in functional outcomes between the two types of reconstructed flaps (P > 0.05).
  
  
  CONCLUSIONS
  The preservation of flap volume was important to achieve superior swallowing capacity; however, it was insufficient to promote the speech outcome. The functional outcomes did not differ depending on the type of flap. © 2015 Wiley Periodicals, Inc. Microsurgery 37:190-196, 2017.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Korea.
authors.forename: Woon Hyeok
authors.initials: WH
authors.lastname: Jeong
authors.affiliation: Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University Health System, Severance Hospital, Seoul, Korea.
authors.forename: Won Jai
authors.initials: WJ
authors.lastname: Lee
authors.affiliation: Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University Health System, Gangnam Severance Hospital, Seoul, Korea.
authors.forename: Tai Suk
authors.initials: TS
authors.lastname: Roh
authors.affiliation: Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University Health System, Severance Hospital, Seoul, Korea.
authors.forename: Dae Hyun
authors.initials: DH
authors.lastname: Lew
authors.affiliation: Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University Health System, Gangnam Severance Hospital, Seoul, Korea.
authors.forename: In Sik
authors.initials: IS
authors.lastname: Yun
mesh_terms: D000328:Adult; D000368:Aged; D002681:China; D015331:Cohort Studies; D003679:Deglutition / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply / Q000637:transplantation; D005927:Glossectomy / Q000379:methods; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000098:blood supply / Q000637:transplantation; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D013065:Speech Intelligibility; D018709:Statistics, Nonparametric; D013524:Surgical Flaps / Q000098:blood supply / Q000637:transplantation*; D013997:Time Factors; D014062:Tongue Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome