Radial Forearm Free Flap Reconstruction of Glossectomy Defects Without Tracheostomy

Area of Science:

• Head and Neck Surgery
• Reconstructive Surgery
• Oncology

Background:

• Glossectomy defects often require complex reconstruction.
• Radial forearm free flap (RFFF) is a common reconstructive option.
• The necessity of tracheostomy tube (TT) placement during RFFF reconstruction for glossectomy defects is debated.

Purpose of the Study:

• To assess the feasibility and safety of RFFF reconstruction for glossectomy defects without the routine use of a tracheostomy tube (TT).

Main Methods:

• Retrospective review of patients undergoing RFFF reconstruction for oral tongue defects.
• Documentation of pre- and intra-operative factors.
• Analysis of post-operative respiratory complications within 30 days, including inability to extubate, pneumonia, or need for re-intubation or TT.

Main Results:

• Twenty-one patients underwent RFFF reconstruction without TT, and 36 with TT.
• Patients without TT had a shorter hospital stay (1.5 days shorter, P < .01).
• No respiratory complications occurred in the no-TT group, while two occurred in the TT group (P = .27).
• Large tongue base defects (>25% resection) and bilateral neck dissection were associated with TT placement (P < .001).

Conclusions:

• RFFF reconstruction of glossectomy defects is feasible without TT in selected patients.
• Patient selection criteria include small tongue base defects (≤25% resection) and unilateral neck dissection.
• Avoiding TT placement can lead to shorter hospital stays and potentially fewer respiratory complications.