The price of free tissue transfer after tongue reconstruction: quantifying the risks

Objectives/Hypothesis: To evaluate the preoperative variables, mean operative time, morbidity, and mortality associated with reconstruction of partial glossectomy defects. Study Design: Retrospective data analysis. Methods: The National Surgical Quality Improvement Program database was queried for patients having undergone glossectomy procedures. The study sample was split into two groups based on the lack or presence of a flap reconstruction. A total of 1,012 glossectomy patients were identified, with 805 undergoing nonflap reconstruction and 207 undergoing free flap reconstruction. Variables evaluated included wound complications, major and minor morbidity, return to the operating room, mortality, and mean operative time. Results: Patients undergoing free flap reconstruction experienced significantly longer mean operative times (482.1 vs. 183.0 minutes, P <.001), were more likely to return to the operating room (odds ratio [OR] = 2.39, 95% confidence interval [CI] = 1.33-4.29, P =.003), and had higher likelihood of wound complications (OR = 5.78, 95% CI = 2.72-12.26, P <.001), major morbidity (OR = 12.39, 95% CI = 7.02-21.85, P <.001), and minor morbidity (OR = 4.20, 95% CI = 2.12-8.33, P <.001). There was no difference in mortality between groups (OR = 8.62, 95% CI = 0.53-141.7, P =.131). Conclusions: Free flap reconstruction of glossectomy defects involving up to half of the tongue is associated with increased morbidity and operative time when compared with nonflap reconstruction. Currently available functional outcomes data for tongue reconstruction are poor. Possible functional impairment must be weighed against the associated morbidity when deciding which defects require reconstruction, and the decision to reconstruct should not be taken lightly. Level of Evidence: 4. Laryngoscope, 127:1551–1557, 2017.