Medial Sural Artery Perforator Flap for Tongue and Oral Cavity Reconstruction With Native Tongue Tip Preservation: Report of Three Cases

Compartmental hemiglossectomy for oral cavity squamous cell carcinoma creates composite tongue/floor defects in which balancing mobility, bulk, and a supple lining is challenging. We report three consecutive reconstructions using a medial sural artery perforator (MSAP) flap, emphasizing preservation of the uninvolved tongue tip left intentionally unattached to maximize residual mobility. A 28-year-old woman, a 50-year-old man, and a 36-year-old woman with lateral tongue SCC underwent compartmental resection with selective neck dissection; defects measured ~4 × 3, 5 × 4, and 6 × 5 cm. Thin fasciocutaneous MSAP flaps (5 × 4, 6 × 5, and 7 × 6 cm) were harvested from the medial calf and inset intraorally after tumor ablation, with end-to-end microvascular anastomoses to cervical recipient vessels (typically the lingual or superior thyroid artery and the external or internal jugular vein). All flaps survived without surgical complications; donor sites were closed primarily. Oral feeding resumed on postoperative day 13, 18, and 12, respectively; speech was comprehensible in all cases after standard rehabilitation. Follow-up occurred 6 months after completion of adjuvant radiotherapy (case 1), during adjuvant radiotherapy (case 2), and 3 months after completion (case 3) with all patients tolerating a full oral diet of any consistency and calf scars were linear and inconspicuous with no lower-limb deficits. These findings suggest that, for medium-sized lateral tongue/floor defects, the MSAP provides a favorable balance of pliability and volume with low donor-site morbidity; when oncologically feasible, preserving and not suturing the native tongue tip may further enhance mobility and functional recovery.