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M. Abraham Kuriakose, MD; Thom R. Loree, MD; Alice Spies, RN, RNFA, CNOR; Sandy Meyers, MS, OTR; Wesley L. Hicks, Jr, MD

Arch Otolaryngol Head Neck Surg. 2001;127:1463-1466.

Background  Successful rehabilitation after ablative surgery requires not only the reconstruction of 3-dimensional form but also the restoration of physiologic function.

Objective  To assess sensory recovery of reinnervated radial forearm flaps used for tongue reconstruction.

Patients and Methods  Seventeen patients, who underwent reconstruction of glossectomy defects with reinnervated radial forearm free flaps, formed the study group. Recovery of sensation was measured by both subjective and detailed objective tests 8 months after surgery. Sensory function of the flap was compared with that of the normal residual tongue or the adjacent oral mucosa and the contralateral forearm donor site.

Results  All patients involved in this study had tongue defects of hemiglossectomy or greater and adjacent floor of the mouth. Sensory recovery was observed in all of the 17 patients within 8 months. Detailed sensory testing showed that median static 2-point discrimination, moving 2-point discrimination, and pressure sensitivity (1.2 cm, 0.8 cm, and 3.7 psi, respectively) were subjectively greater in the innervated forearm flaps than in the contralateral forearm donor site (2.3 cm, 1.7 cm, and 4.6 psi, respectively) (P=.064) and similar to those of the normal tongue (0.9 cm, 0.5 cm, and 3.6 psi).

Conclusions  In all modalities examined, sensate free flaps proved superior in sensory fidelity to the native forearm donor site and closely approached that of the normal tongue. Microsurgical reinnervation of flaps should be considered in tongue reconstruction.

From the Department of Head and Neck Surgery, Roswell Park Cancer Institute, Buffalo, NY.

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