Abstract:

Objective To compare the curative effects of facial-submental artery island flap and free forearm flap in repairing post-resection defects of tongue squamous cell carcinoma. Methods A retrospective analysis was conducted on the clinical data of 133 patients with tongue squamous cell carcinoma who underwent radical tumor resection followed by defect reconstruction at the Affiliated Stomatological Hospital of Medical School of Nanjing University from January 2019 to January 2023. Patients were divided into two groups based on the flap type： the submental group （n=66， reconstructed with facial-submental artery island flap） and the forearm group （n=67， reconstructed with free forearm flap）. The surgical related indicators （intraoperative blood loss， operative duration， length of hospital stay， and flap survival rate）， pre- and post-operative oral function [mouth opening degree， Standardized Swallowing Assessment （SSA） score， and mastication score]， quality of life [scores on the Generic Quality of Life Inventory 74 （GQOLI-74， including psychological function， physical function， social function， and material living status domains）]， complications （hematoma， graded according to the Clavien-Dindo classification）， donor site adverse events （scar hyperplasia， pigmentation， numbness/paresthesia） and lymph node metastasis rate within 18 months after surgery were compared between the two groups. Results The submental group exhibited significantly lower intraoperative blood loss [（242.57±25.39） ml vs. （326.29±35.94） ml， t=15.50， P<0.001]， shorter operative duration [（356.28±32.68） min vs. （408.31±48.31） min， t=7.26， P<0.001]， and shorter hospital stay [（13.84±2.92） d vs. （17.41±3.84） d， t=6.03， P<0.001] compared to the forearm group. The flap survival rates in the submental group and forearm group were 100% （66/66） and 95.52% （64/67）， respectively， with no statistically significant difference （χ²=1.33， P=0.248）. No significant intergroup differences were observed in post-operative mouth opening degree [（2.81±0.35） cm vs. （2.73±0.31） cm， t=1.40， P=0.165] or SSA score [（29.72±3.05） points vs. （30.28±3.34） points， t=1.01， P=0.315]. However， the submental group had a significantly higher post-operative mastication score [（3.36±0.35） points vs. （3.14±0.27） points， t=4.06， P<0.001]. Both groups showed significant improvements in mouth opening degree and mastication score， and a significant reduction in SSA score post-operatively （all P<0.05）. In terms of quality of life， post-operatively， the submental group scored significantly higher compared with the forearm group in all GQOLI-74 domains： psychological function [（70.34±3.15） points vs. （68.52±2.95） points， t=3.44， P<0.001]， physical function [（71.58±3.21） points vs. （69.34±3.76） points， t=3.69， P<0.001]， social function [（70.25±3.77） points vs. （68.36±2.70） points， t=3.33， P=0.001]， material living status [（72.48±3.20） points vs. （70.18±2.85） points， t=4.38， P<0.001]. Both groups demonstrated significant post-operative improvements in all GQOLI-74 domains （all P<0.05）. Compared with the forearm group， the submental group had significantly lower rates of hematoma [1.52% （1/66） vs. 11.94% （8/67）， χ²=4.19， P=0.041]， scar hyperplasia [0 （0/66） vs. 14.93% （10/67）， χ²=10.65， P=0.001]， pigmentation [6.67% （4/66） vs. 29.85% （20/67）， χ²=12.72， P<0.001]， and numbness/paresthesia [7.58% （5/66） vs. 32.84% （22/67）， χ²=13.11， P<0.001]. Clavien-Dindo classification revealed a significantly more favorable complication severity profile in the submental group [58 cases （87.88%） of grade 0， 6 cases （9.09%） of grade Ⅰ， 2 cases （3.03%） of grade Ⅱ] compared to the forearm group [20 cases （29.85%） of grade 0， 25 cases （37.31%） of grade Ⅰ， 15 cases （22.39%） of grade Ⅱ， 5 cases （7.46%） of grade Ⅲ， 2 cases （2.99%） of grade Ⅳ； Z=4.53， P<0.001]. There was no statistically significant difference in lymph node metastasis rates within 18 months postoperatively between groups [15.15% （10/66） vs. 13.43% （9/67）， χ²=0.08， P=0.777]. Conclusions Both free forearm flap and facial-submental artery island flap are effective for reconstructing soft tissue defects after radical tongue cancer resection. However， the facial-submental artery island flap offers superior outcomes in reducing operative duration， blood loss， and complication rates， while improving mastication function and overall quality of life.

Key words: Tongue neoplasms, Surgical flaps, Tissue defect repair