A Pilot Study: Free Flap Atrophy in Tongue Reconstruction Using 3D Volumetric Analysis

Area of Science:

• Oral and Maxillofacial Surgery
• Plastic Surgery
• Biomedical Engineering

Background:

• Oral free flap reconstruction is crucial for restoring function after glossectomy.
• Understanding long-term flap volume changes is essential for optimizing patient outcomes.
• Previous studies have not fully elucidated the factors influencing volumetric changes in non-osseous oral free flaps.

Purpose of the Study:

• To identify factors influencing volume change in non-osseous oral free flap reconstruction.
• To quantify the volumetric changes of muscular and adipose tissue within free flaps.
• To correlate imaging-derived flap volumes with clinical and surgical variables.

Main Methods:

• Retrospective review of oral tongue free flap reconstructions (2014-2019).
• Inclusion of patients with three postoperative cross-sectional imaging studies at specific intervals.
• Three-dimensional segmentation and volume measurement of flap components using Materialise MIMICS software.

Main Results:

• Median overall flap volume loss was 53.2% at over two years post-reconstruction.
• Radial forearm flaps showed higher atrophy (58.1%) compared to anterolateral thigh flaps (45.4%).
• Glossectomy extent, obesity, and base of tongue involvement significantly impacted flap atrophy rates over time.

Conclusions:

• Glossectomy extent is a positive predictor of flap atrophy, while obesity and base of tongue involvement are negative predictors.
• The observed median atrophy of 53.2% at over two years suggests a greater tissue loss than traditionally expected.
• These findings necessitate a re-evaluation of flap size selection and postoperative management strategies.