Intraoral microvascular anastomosis: A minimally invasive technique for lateral arm free flap tongue reconstruction

Reconstruction of tongue defects following oncologic resection remains a clinical challenge, requiring both functional and aesthetic restoration. Lateral arm free flap (LAFF) provides a thin and pliable option with minimal donor-site morbidity. However, conventional techniques require cervical incisions for microvascular anastomosis, which may increase scarring and postoperative complications. This study presents a novel intraoral microvascular anastomosis technique that allows tongue reconstruction with LAFF without additional cervical incisions.

Two patients with extensive tongue leukoplakia, who did not require neck dissection, underwent partial glossectomy followed by immediate reconstruction using LAFF. Vascular anastomoses were performed intraorally between the flap pedicle and the lingual artery and deep lingual vein, eliminating the need for cervical incisions.

Both flaps survived without vascular compromise. Oral feeding was resumed by postoperative day 5. Speech articulation and tongue mobility were preserved. No wound infections, donor site complications, or esthetic concerns were observed. At the 3-month follow-up, both patients demonstrated satisfactory functional and cosmetic outcomes, with no evidence of disease recurrence.

The use of a lateral arm free flap with transoral vascular anastomosis represents a viable and effective approach for tongue reconstruction, providing excellent functional and cosmetic results. This technique may be considered a promising alternative for well-selected cases.