J Reconstr Microsurg 2000; Volume 16(Number 1): 0007-0014
DOI: 10.1055/s-2000-7535
Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel: +1(212)760-0888

Tongue Reconstruction with a Combined Brachioradialis-Radial Forearm Flap

James R. Sanger, Bruce H. Campbell, Zhong Ye, N. John Yousif, Hani S. Matloub
  • Departments of Plastic and Reconstructive Surgery, and Otolaryngology and Human Communication, Medical College of Wisconsin, Milwaukee, Wisconsin
Further Information

Publication History

Publication Date:
31 December 2000 (online)

ABSTRACT

-Total glossectomy adversely affects speech and swallowing, and subsequent reconstruction results in limited functional return. The radial forearm flap has been reliably used to resurface glossectomy defects, but has limited bulk with which to aid in palatoglossal contact for speech. The authors have modified the forearm flap by incorporating a segment of brachioradialis muscle, to increase bulk posteriorly and to aid in speech.

Sufficient muscle perforators arise from the proximal brachial artery and enter the brachioradialis to permit transfer of the muscle with the fasciocutaneous forearm flap as a single free-flap unit. The muscle is folded onto itself and enclosed within the forearm flap skin to create a neotongue. Coaptation of the antebrachial cutaneous nerves to the lingual nerve can provide a sensate flap.

Successful transfer of the combined brachioradialis/forearm flap in a patient who had undergone total glossectomy resulted in a neotongue with good shape. Speech was rated good by a speech pathologist, and palatoglossal contact was observed on cineoradiograph. No functional loss at the donor site occurred.

Inclusion of the brachioradialis muscle with the radial forearm flap as a combined unit results in a neotongue with good form and increased bulk posteriorly at the base, compared to a standard fasciocutaneous flap alone. This is a useful variation of the forearm flap. Sensory return is possible if the medial and/or lateral antebrachial cutaneous nerves of the flap are coapted to the lingual nerve.