Tongue reconstruction using VRAM flap after staged neck dissection and total glossectomy for squamous cell carcinoma

Abstract

Squamous cell carcinoma (SCC) is a frequent cancer of the oral cavity, more aggressive in young patients and mostly affecting males with a history of smoking and alcohol consumption. After oncological excision, reconstruction is possible using an array of flaps, such as the radial forearm flap, anterolateral thigh flap, rectus abdominis flap, each with various indications, advantages and disadvantages. Functional reconstruction is difficult, as the multiple and highly specialized muscles of the tongue cannot be replaced by any of the above-mentioned options. A 23 year-old male presented with squamous cell carcinoma of the anterior ⅔ of the tongue and left submandibular enlarged lymph nodes (T₃N_2bM₀, stage IVA). A preoperative nutritional and metabolic optimization was established using a percutaneous endoscopic gastrostomy, tracheostomy, then we performed a total glossectomy with modified radical bilateral neck dissection and VRAM flap reconstruction. Postoperatively the patient developed an orocervical salivary fistula and partial skin necrosis of the upper left cutaneous laterocervical flap. The postoperative pathology confirmed extended SCC of the tongue. The patient received adjuvant radiotherapy postoperatively. There were no major complications, and the one-year follow-up concluded on normal feeding, satisfactory speech recovery, and no recurrence.