Comparison of innervated and noninnervated free flaps in oral reconstruction

Thirteen patients who had undergone ablative surgery for advanced squamous cell carcinoma in which more than half of the tongue had been resected unde rwent reconstruction in which the cutaneous nerve of a free flap was anasto mosed to the stump of the transected lingual nerve. Eight of the patients u nderwent reconstruction with an innervated anterolateral thigh flap and fiv e patients underwent reconstruction with an innervated rectus abdominis mus culocutaneous flap. Sensory recovery of the flap at least 6 months postoper atively was compared in these 13 patients and in 16 additional patients who received noninnervated versions of the same flaps for the same defect. The degree of sensory recovery of innervated thigh flaps was significantly gre ater than that of noninnervated ones in all modalities and that of innervat ed rectus abdominis flaps was also greater than that of noninnervated flaps , except for hot and cold perception. These results indicate that sensory r egrowth occurs in most areas through the surgically created pathways. Howev er, results of Semmes-Weinstein testing showed that recovery did not reach the level of protective sensation in either type of innervated flap. Althou gh these findings must be followed by additional objective and functional t ests and the need for sensory reeducation should be considered, this simple operative procedure can improve postoperative intraoral function and shoul d be attempted whenever possible after ablative surgery.