Tongue reconstruction using radial forearm flap

Background. Squamous cell carcinoma (SCC) of the tongue is a prevalent and aggressive oral cancer. Radical surgical treatment for SCC is crucial for improving survival rates, often leads to significant intraoral defects necessitating reconstruction. Case report. A 35-year-old male presented with a six-month history of painful non-healing ulcer on the right lateral border of the tongue, diagnosed as poorly differentiated SCC. Imaging revealed muscle involvement, and the patient underwent subtotal glossectomy with bilateral selective neck lymph nodes dissection. Reconstruction was performed using a free radial forearm fasciocutaneous flap. Surgical technique. The flap was designed with a 6x13 cm rectangular template and raised on a suprafascial plane preserving essential structures. The pedicle was tunneled subcutaneously to reach recipient vessels in the neck, followed by microvascular anastomosis. The flap was inset to restore tongue and floor of mouth function. Results. One year after surgery, the patient showed satisfactory functional outcomes, including normal diet intake and well-mucosalized flap. Slight speech impairment due to neotongue contracture was noted, attributed partly to postoperative radiotherapy. The donor site on the forearm healed well with manageable hypertrophic scarring. Conclusion. Radial forearm flap is a reliable option for tongue reconstruction, providing satisfactory cosmetic and functional results with manageable donor site morbidity.