Functional tongue reconstruction using innervated TDAP versus ALT free flaps: a retrospective paired-cohort study.

OBJECTIVES: To compare the postoperative complications, speech function, quality of life (QoL), overall clinical outcomes and flap volume loss of tongue reconstruction using anterolateral thigh (ALT) versus innervated-thoracodorsal artery perforator (iTDAP) flaps following hemiglossectomy for tongue squamous cell carcinoma (TSCC). MATERIALS AND METHODS: Clinical data of 130 TSCC patients who underwent tongue reconstruction with ALT or iTDAP flaps were retrospectively analyzed. We compared two types of free flaps in terms of their characteristics and associated postoperative complications (including fistula, hematoma, infection, dehiscence and lower-limb venous thrombosis). Flap volume loss was assessed based on intraoperative and postoperative measurements. The University of Washington Quality of Life (UW-QOL) questionnaire, Speech Handicap Index (SHI) questionnaire and Vancouver Scar Scale (VSS) were used to evaluate quality of life (QoL), speech function and scar appearance at 3, 6 and 12 months postoperatively. RESULTS: The harvest time and length of the vascularized pedicle with vessels of a similar diameter were similar between the iTDAP and ALT groups (p > 0.05). Additionally, the postoperative complication rate and scar appearance were not significantly different between patients who underwent reconstruction with iTDAP flaps and those who underwent reconstruction with ALT flaps (p > 0.05). Notably, iTDAP flap recipients presented significantly improved QoL scores, higher SHI scores and shorter durations of bed rest (p < 0.05). Furthermore, flap volume loss was significantly lower in the iTDAP group compared with the ALT group (p < 0.05). CONCLUSION: ITDAP flaps provide similar safety and complication rates as ALT flaps while offering better quality of life, improved speech function, shorter recovery times and lower flap volume loss, making them a viable alternative for functional tongue reconstruction. TRIAL REGISTRATION: The study was retrospectively registered at ClinicalTrials.gov (registration number: NCT06599801) on September 30, 2024.