Total Tongue Reconstruction with Innervated Latissimus Dorsi Free Flap

Total tongue resection result in severe speech problem, swallowing difficulty and life threatening aspiration. When a total glossectomy is performed, the functional recovery of swallowing, articulation, and airway protection are important for maintaining life quality of the patient. To achieve good functional results, First, the donor tissue should be bulky. Second, the tissue should be pliable and capable of movement. Third, the neotongue should be innervated by anastomosis to the hypoglossal nerve. Innervated latissimus dorsi free flap satisfies the above conditions. The authors performed two immediate total tongue reconstruction using a innervated latissimus dorsi myocutaneous free flap in which the thoracodorsal nerve was anastomosed to the hypoglossal nerve. Decanulation was performed on the 15th and 20th day respectively after the operation. The oral intake of pureed diet was possible in both patients without aspiration. After 3 months, it was confirmed in videofluoroscopic study that the neotongue was able to contact with the palate effectively. And the articulation was satisfactory. Considering speech and feeding rehabilitation, innervated latissimus dorsi flap can be more valuable method of tongue reconstruction than any other methods and we recommend it for better life quality of the patient.

Reconstruction of Midface Defect with Latissimus Dorsi Myocutaneous Free Flap / 영남의대학술지

We report 2 cases of midface defect reconstructed with latissimus dorsi myocutaneous free flap. In these cases, the main points to cover the defects were as follows: 1. For the contour of zygoma and maxilla, it was well preserved without bone graft which was not used for second stage reconstruction. In first case, for application of artificial eyes and in second case, for operation after full development. 2. For the drainage of paranasal sinuses, we made the nostril with skin graft, and it was well preserved without any complications during follow up. 3. It was sufficient to cover the defect with latissimus dorsi muscle well designed before surgery and thick enough to fill the defect. 4. In second case, the remained defect of palate and maxilla was not covered for the appropriate reconstructions after full development. In conclusions, we experienced two cases of midface defect reconstructed with latissimus dorsi myocutaneous free flap without any complication and with good results.