Reinnervated free gracilis flap with basal curtain barrier for tongue reconstruction: a case series and surgical technique

Conventional free flaps for tongue reconstruction often result in adhesion and limited mobility. This study presents a case series of two patients evaluating a novel reinnervated free gracilis flap with a basal curtain barrier design. Two patients with cT3N0M0 tongue squamous cell carcinoma underwent hemiglossectomy. Case 1 was reconstructed using the novel technique (gracilis muscle with a skin island barrier), while Case 2 was reconstructed with a standard reinnervated gracilis muscle flap without a skin island. In Case 1, the skin island effectively closed the floor-of-mouth defect, creating a barrier that prevented muscle-to-mucosa adhesion. Compared to Case 2, Case 1 demonstrated significantly superior tongue mobility, higher swallowing efficiency, and clearer speech intelligibility. The basal curtain barrier design effectively prevents tethering of the reconstructed tongue to the floor of the mouth. It offers superior functional freedom and rehabilitation outcomes for hemiglossectomy defects compared to sole muscle flaps.