Reconstruction of Tongue Defects with Rectus Abdominis Free Flap

Abstract

The tongue is arguably amongst the most valuable organs within the body because of its importance in day-to-day functions like swallowing, eating, and speaking. While severe trauma can lead to extensive tongue lesions, defects are generally a result of oncologic resection as the tongue is the most common site of oral cavity malignancy. With standard oncological margin recommendations of about 2 cm for squamous cell carcinoma, it is easy for even the smallest oral cavity malignancy to become a significantly large lesion necessitating free flap reconstruction. The complexity of the tongue presents significant reconstructive challenge due to its inclusion of proprioceptive feedback and innervation for functional recovery. The evaluation on how to reconstruct a tongue defect depends mostly on size, availability of donor vessels, characteristics of anatomical involvement, miscellaneous oncologic or trauma-related considerations, and ultimately surgeon preference. This chapter will discuss the Rectus Abdominis Free Flap (RAFF). It will focus on the primary indications and basic techniques involved for the flap; however, additional review is suggested for the reader to become more familiar with the multitude of potential variations that may exist within this reconstructive technique. In this text, referential “basic technique” is intended to be defined as a musculocutaneous graft based around the deep inferior epigastric artery, vein, subsequent perforators, and potentially nerves.