Scapular tip-thoracodorsal artery perforator free flap for total/subtotal glossectomy defects: Case series and conformance study

Background: Reconstruction of the tongue and floor of mouth after total/subtotal glossectomy poses a major challenge for reconstructive surgeons. Speech and deglutition after total glossectomy are usually significantly impaired, affecting the quality of life of these patients. Maintaining an adequate volume of the reconstruction is paramount to optimize speech and swallowing function postoperatively. Aim: To report a novel free flap reconstructive technique based on the subscapular system. Methods: A preliminary cases series of patients undergoing reconstruction with scapular tip-thoracodorsal artery perforator (STTDAP) flap after total/subtotal glossectomy is reported. Conformance of the scapular tip with respect to the inner aspect of the mandible is measured in a sample of 10 subjects (20 sides) with normal scapular and mandibular anatomy, considering both the entirety of the scapular tip (overall conformance) and its caudal border (border conformance). Association between scapular morphology and conformance to the mandible was assessed statistically. Results: Three patients matched inclusion criteria. Mean follow-up was 7 months. Speech and deglutition result was satisfactory in 2 patients and poor in 1 patient. Overall and border conformance were high (root mean square: 2.23 mm and 3.14 mm, respectively). Shape and angular aperture of the scapular tip significantly affected overall and border conformance, respectively. Conclusion: Reconstruction of the tongue with STTDAP flap after total glossectomy is feasible. Conformance between the scapular tip and mandible is optimal and, although based on preliminary evidence, patients might benefit from this technique in terms of functional outcomes.