Abstract：
OBJECTIVE: Anterior 2/3rds glossectomy results in significant patient morbidity due to speech and swallowing impairment. Microvascular free flap reconstruction compensates for large volume defects. Flap volume is based on the adipose content of the donor site and varies by patient body mass index (BMI) and donor site location. We sought to correlate flap thickness at different donor sites with patient BMI to determine optimal donor site selection.
METHODS: Patients with CT scans of the oral cavity, thorax and lower extremity were identified and included. The volumes of the anterior 2/3rds of the tongue were measured and recorded using computed tomography-generated modeling. Pre-muscular tissue thicknesses at anterolateral thigh (ALT), deep inferior epigastric artery (DIEP), latissimus dorsi, and parascapular donor sites were measured. The donor site adequency was defined as reconstructing the tongue volume within 10% of the ideal volume required and stratified based on patient BMI.
RESULTS: In 144 patients, the average anterior 2/3rds glossectomy defect was 100.3 cm3. Glossectomy defect size was highly correlated with BMI (p < 0.001). The DIEP flap had the largest volume (155.4 cm3), followed by latissimus (105.6 cm3), parascapula (97.8 cm3), and ALT (60.5 cm3). For patients with BMI ≤ 30, the DIEP flap best reconstructed native tongue volume (up to 113 % of native tongue volume). In patients with BMI > 30.1, native tongue volumes were approximated by the latissimus flap (89-92 % of native tongue) and parascapular flap (85-95 % of native tongue volume). In BMI > 30.1 the DIEP flap provided excess tissue bulk (129-135 % of native tongue volume).
CONCLUSIONS: The DIEP flap more closely approximates the volume needed to reconstruct anterior two-thirds tongue defects for BMIs ≤ 30. The subscapular system flaps provided the best volume match for BMIs > 30 and the DIEP flap provided excess tissue bulk which could be adjusted in the reconstruction process.
METHODS: Patients with CT scans of the oral cavity, thorax and lower extremity were identified and included. The volumes of the anterior 2/3rds of the tongue were measured and recorded using computed tomography-generated modeling. Pre-muscular tissue thicknesses at anterolateral thigh (ALT), deep inferior epigastric artery (DIEP), latissimus dorsi, and parascapular donor sites were measured. The donor site adequency was defined as reconstructing the tongue volume within 10% of the ideal volume required and stratified based on patient BMI.
RESULTS: In 144 patients, the average anterior 2/3rds glossectomy defect was 100.3 cm3. Glossectomy defect size was highly correlated with BMI (p < 0.001). The DIEP flap had the largest volume (155.4 cm3), followed by latissimus (105.6 cm3), parascapula (97.8 cm3), and ALT (60.5 cm3). For patients with BMI ≤ 30, the DIEP flap best reconstructed native tongue volume (up to 113 % of native tongue volume). In patients with BMI > 30.1, native tongue volumes were approximated by the latissimus flap (89-92 % of native tongue) and parascapular flap (85-95 % of native tongue volume). In BMI > 30.1 the DIEP flap provided excess tissue bulk (129-135 % of native tongue volume).
CONCLUSIONS: The DIEP flap more closely approximates the volume needed to reconstruct anterior two-thirds tongue defects for BMIs ≤ 30. The subscapular system flaps provided the best volume match for BMIs > 30 and the DIEP flap provided excess tissue bulk which could be adjusted in the reconstruction process.
摘要：
目的：前路2/3舌片切除术导致患者由于言语和吞咽障碍而发病率显著。微血管游离皮瓣重建可补偿大体积缺损。皮瓣体积基于供体部位的脂肪含量，并因患者体重指数（BMI）和供体部位而变化。我们试图将不同供体部位的皮瓣厚度与患者BMI相关联，以确定最佳的供体部位选择。
方法：对口腔进行CT扫描的患者，确定并包括胸部和下肢。使用计算机断层扫描生成的模型测量并记录舌前2/3rds的体积。大腿前外侧肌肉组织厚度（ALT），腹壁下动脉(DIEP),背阔肌,并测量了肩胛骨旁的供体部位。供体部位的充分性被定义为在所需的理想体积的10%内重建舌头体积并基于患者BMI分层。
结果：在144名患者中，平均前2/3rds舌片切除术缺损为100.3cm3。舌叶切除缺损大小与BMI高度相关(p<0.001)。DIEP皮瓣体积最大(155.4cm3),紧随其后的是latissimus(105.6cm3)，肩胛骨(97.8cm3),和ALT（60.5cm3）。对于BMI≤30的患者，DIEP皮瓣最好重建天然舌体积（高达天然舌体积的113%）。在BMI>30.1的患者中，背阔肌皮瓣（占天然舌的89-92％）和肩胛骨旁皮瓣（占天然舌体积的85-95％）近似了天然舌体积。在BMI>30.1时，DIEP皮瓣提供了多余的组织体积（天然舌体积的129-135％）。
结论：DIEP皮瓣更接近重建BMI≤30时前三分之二舌缺损所需的体积。肩胛骨下系统皮瓣为BMI>30提供了最佳的体积匹配，DIEP皮瓣提供了多余的组织体积，可以在重建过程中进行调整。
方法：对口腔进行CT扫描的患者，确定并包括胸部和下肢。使用计算机断层扫描生成的模型测量并记录舌前2/3rds的体积。大腿前外侧肌肉组织厚度（ALT），腹壁下动脉(DIEP),背阔肌,并测量了肩胛骨旁的供体部位。供体部位的充分性被定义为在所需的理想体积的10%内重建舌头体积并基于患者BMI分层。
结果：在144名患者中，平均前2/3rds舌片切除术缺损为100.3cm3。舌叶切除缺损大小与BMI高度相关(p<0.001)。DIEP皮瓣体积最大(155.4cm3),紧随其后的是latissimus(105.6cm3)，肩胛骨(97.8cm3),和ALT（60.5cm3）。对于BMI≤30的患者，DIEP皮瓣最好重建天然舌体积（高达天然舌体积的113%）。在BMI>30.1的患者中，背阔肌皮瓣（占天然舌的89-92％）和肩胛骨旁皮瓣（占天然舌体积的85-95％）近似了天然舌体积。在BMI>30.1时，DIEP皮瓣提供了多余的组织体积（天然舌体积的129-135％）。
结论：DIEP皮瓣更接近重建BMI≤30时前三分之二舌缺损所需的体积。肩胛骨下系统皮瓣为BMI>30提供了最佳的体积匹配，DIEP皮瓣提供了多余的组织体积，可以在重建过程中进行调整。
