Tongue reconstruction: Rebuilding mobile three-dimensional structures from immobile two-dimensional substrates, a fresh cadaver study

Algorithmically designed flaps in tongue reconstruction: a feasibility analysis

PURPOSE

Despite the significance and complexity of tongue reconstruction surgery, a digital tool for flap design is currently lacking. This study investigates the effectiveness of employing inverse finite element method (IFEM) for meticulously designing the geometric characteristics of harvested tissue (free flap) for tongue reconstruction.

METHODS

In the case of an artificially simulated hemiglossectomy, IFEM algorithm was applied for algorithmic flap design. The method's effectiveness was evaluated by assessing flap deformation in a simplified virtual reconstruction, focusing on parameters such as stress, strain, and thickness.

RESULTS

The IFEM algorithm successfully generated an optimal flap design for the intended surgical removal. Analysis of the flap's overall surface area, deformation characteristics, and safety margins demonstrated the feasibility of the deformation. Notably, the stress and thickness assessments suggested that the flap's tension post-surgery would not adversely affect the mobility of the reconstructed tongue, suggesting a positive outcome for functional recovery.

CONCLUSION

The IFEM demonstrates significant potential as a tool for precise free flap design in tongue reconstruction surgeries. Its application could lead to improved surgical accuracy and better quality of life for patients undergoing such procedures.

Thin superficial inferior epigastric artery perforator flap for reconstruction of the tongue

The superficial inferior epigastric artery (SIEA) flap is widely used in the repair of large soft tissue defects of the extremities and in breast reconstruction. Because of the high fat content of the abdomen, it has been less used for glossectomy reconstruction. Here we present a series of seven patients who each underwent reconstruction with a thin SIEA flap after resection of the tongue. There were six men and one woman (mean age 48, range 24-66 years). All patients underwent preoperative computed tomographic (CT) angiography, and colour Doppler ultrasound (US) was used to select and map the most suitable SIEA. The flap was raised above the Scarpa's layer while adjusted the plane of dissection according to the specific needs for bulk in each case. All the flaps survived; one flap required a secondary anastomosis because of a venous anastomotic embolus. The size of flap used was 5.0cm×6.0cm - 7.0cm×9.0cm, and the flap was 0.8cm-1.4cm thick. The functional outcome was evaluated at 6 - 18 months follow up, when speech and swallowing were both good in all cases. The dissection above the pubic symphysis is an important refinement of the SIEA flap, and we conclude that the thin SIEA flap is a good choice for reconstruction after excision of cancer of the tongue.