Bilobed perforator free flaps for combined hemitongue and floor-of-the-mouth defects.

Summary Introduction: Combined hemiglossectomy and floor-of-the-mouth defects need
accurate reconstructive planning to restore swallowing and speech function. The aim of this
prospective study was to evaluate outcomes of the bilobed design applied to perforator free
flaps for combined hemitongue and floor-of-the-mouth defects.
Patients and methods: Twelve patients with a mean age of 71 years (range, 60e84) addressed
to combined hemiglossectomy and floor-of-the-mouth resection and bilobed-shaped perforator
free-flap reconstruction were prospectively enrolled. Defects were classified as follows: type
1, including only the anterior mobile portion of the tongue (n Z 3); type 2, involving both mobile
tongue and tongue base (n Z 6); and type 3, including segmental mandibulectomy combined
with a type 1 or type 2 defect (n Z 3). The KruskaleWallis and Bonferroni post hoc tests
were used to compare outcomes.
Results: Type 1 defects were reconstructed by three anterolateral thigh (ALT) perforator flaps;
type 2 defects were reconstructed by four ALT flaps and two vertical deep inferior epigastric
perforator flaps; and type 3 defects were restored by three osteocutaneous fibula flaps. Eleven
flaps (91.6%) healed uneventfully, while one (8.4%) suffered a small area of skin necrosis whose
revision did not compromise functional results. Six patients achieved normal intelligible
speech, five had acceptable intelligible speech and one had unintelligible speech
(p Z 0.356). Swallowing function was considered normal in eight patients and with mild
impairment in four (p Z 0.178). Cosmesis resulted excellent in seven patients and good in five
(p Z 0.855).
Conclusion: The bilobed-shaped perforator free flaps were shown to be a safe and predictable
solution for combined hemitongue and floor-of-the-mouth defects providing optimal aesthetic
and functional outcomes.