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A Pilot Study: Free Flap Atrophy in Tongue Reconstruction Using 3D Volumetric Analysis.

Authors :
Gewirtz JI
Zhao S
Brock G
Luttrull MD
Sethuraman S
Kang SY
VanKoevering KK
Seim NB
Source :
The Annals of otology, rhinology, and laryngology [Ann Otol Rhinol Laryngol] 2024 Mar; Vol. 133 (3), pp. 253-260. Date of Electronic Publication: 2023 Oct 03.
Publication Year :
2024

Abstract

Objective: To identify factors influencing volume change in non-osseous oral free flap reconstruction using postoperative cross-sectional imaging and 3-dimensional segmentation of the free flap's muscular and adipose tissue content.<br />Methods: Oral tongue free flap reconstruction cases (2014-2019) were reviewed with inclusion of patients with 3 postoperative, cross-sectional imaging studies with 1 within 6 months, 1 within 1 year, and 1 that spanned 2 years post-reconstruction. Exclusion criteria included recurrence, significant dental artifact, bony reconstruction, and flap failure. Demographics, risk factors, and surgical/clinical treatments were identified. Flap volumes were measured using Materialise MIMICS.<br />Results: Twenty-two patients met strict inclusion criteria. Four flaps were anterolateral thighs and 18 radial forearms. Median percent volume loss greater than 2 years post-reconstruction was 53.2% overall, 58.1% for radial forearms, and 45.4% for ALTs (21.4% for adipose tissue and 57.4% for muscular tissue). Univariate analysis revealed glossectomy amount was associated with percent volume loss ( P  = .0417). Each successive postoperative month, the flap decreased by 1.54% ( P  < .0001). Checking for the interaction effect, the percent of flap loss across time was different for glossectomy amount ( P  = .0093), obesity status ( P  = .0431), and base of tongue involvement ( P  = .0472).<br />Conclusion: Glossectomy type, and thus flap size, is a positive predictor for flap atrophy. Obesity and base of tongue involvement are negative predictors for flap atrophy. The amount of tissue loss may differ from classical teachings with median atrophy 53.2% greater than 2 years post-reconstruction.<br />Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Details

Language :
English
ISSN :
1943-572X
Volume :
133
Issue :
3
Database :
MEDLINE
Journal :
The Annals of otology, rhinology, and laryngology
Publication Type :
Academic Journal
Accession number :
37789590
Full Text :
https://doi.org/10.1177/00034894231204720