The innervated gracilis musculocutaneous flap for total tongue reconstruction

A functional neotongue following total glossectomy requires both soft-tissu e bulk and reconstruction of muscle function. We used innervated transverse gracilis musculocutaneous flaps to reconstruct total glossectomy defects i n eight patients. The obturator nerve to the gracilis muscle was approximat ed to the hypoglossal nerve to reinnervate the gracilis muscle by using mic rosurgical technique. The cutaneous paddle of the gracilis flap easily supp lies sufficient bulk to replace the total glossectomy defect. Follow-up of patients ranged from 3 to 47 months. All patients were able to resume oral feeding. Electromyographic studies performed on one patient showed reinnerv ation of the flap with active elevation of the posterior pharynx. Ultimatel y. seven patients died because of recurrence of their disease. The innervat ed gracilis musculocutaneous nap may benefit patients who have a total glos sectomy by allowing them to achieve a more functional recovery.