Main Article Reconstruction of the tongue with reinnervated rectus abdominis musculoperitoneal flaps after hemiglossectomy GUIQING LIAO, MD, PHD, YUXIONG SU, MD, JINMING ZHANG, MD, PHD*, JINSONG HOU, MD, PHD, YIYANG CHEN, MD, MA LI, MD† Abstract Reconstruction of the tongue after glossectomy is a primary objective in the process of improving the life quality of patients suffering from tongue cancer. We developed a new method of surgical reconstruction of the tongue after hemiglossectomy, with reinnervated rectus abdominis musculoperitoneal flaps. The rectus abdominis musculoperitoneal flap consisted of the rectus muscle, posterior rectus sheath, peritoneum, the 10th, 11th and 12th intercostal nerves, and the deep inferior epigastric artery and veins. Five patients underwent immediate reconstruction of the tongue with rectus abdominis musculoperitoneal flaps after hemiglossectomy. The intercostal nerves were anastomosed to the descending branch of the hypoglossal nerve. All transplanted flaps survived. The peritoneum was replaced by squamous epithelium eight weeks after surgery. During the follow-up period, the contour and function of the reconstructed tongues was satisfactory. Our experience indicates that reconstruction of the tongue with rectus abdominis musculoperitoneal flaps after hemiglossectomy is a suitable, cosmetically acceptable method. Key words: Rectus Abdominis; Peritoneum; Reconstructive Surgical Procedure; Tongue Neoplasms; Glossectomy Introduction Reconstruction of the tongue after glossectomy is a primary objective in the process of improving the life quality of patients suffering from tongue cancer. The anatomy and function of the tongue are so complex that restoring its functionality after extirpative procedures has proved very difficult. With the development of microsurgical procedures, various techniques aimed at grafting free vascularized tissue into the remnant of the tongue have been widely attempted. Even so, current reconstruction techniques that yield satisfactory results in the treat- ment of tongue cancer are far from effective. In recent years, the rectus abdominis myocuta- neous flap, consisting of the skin paddle, anterior rectus sheath and rectus muscle, has been considered to be one of the most suitable flaps for the functional reconstruction of the tongue after total or subtotal glossectomy. 1–4 However, for patients who have undergone hemiglossectomy, the rectus abdominis myocutaneous flaps are excessively bulky, lack plia- bility and may have hair. In our opinion, a better option for tongue reconstruction after hemiglossectomy was use of the multilayer rectus abdominis musculoperitoneal flap, recently introduced in reconstructive surgery procedures as a modification of the rectus abdominis myocutaneous flap. The rectus abdominis musculo- peritoneal flap consists of the rectus muscle, post- erior rectus sheath, peritoneum and a vascular pedicle that includes the deep inferior epigastric artery and veins. The rectus abdominis musculoperi- toneal flap has the distinct advantages of being thin, pliable and without subcutaneous fat, and of having the potential to generate mucosa. It can be assumed that a flap with peritoneum as the surface of the reconstructed tongue would have better tissue compliance than a myocutaneous flap, and the bulk of the transferred tissue would also be smaller. Thus, in order to improve the functional outcomes of tongue reconstruction, we trialled the use of reinnervated rectus abdominis musculoperitoneal flaps, with the intercostal nerves conjoined to the descending branch of the hypoglossal nerve. From 2003 to 2004, five patients underwent this reconstruc- tive procedure, with inspiring results. Patients and methods Patient data From October 2003 to September 2004, five patients suffering from carcinoma of the tongue underwent From the Departments of Oral and Maxillofacial Surgery, *Department of Plastic Surgery and † Department of Oral Pathology, Guanghua College of Stomatology, Sun Yat-sen University, Guangzhou, PR China. Accepted for publication: 18 August 2005. The Journal of Laryngology & Otology (2006), 120, 205–213. # 2006 JLO (1984) Limited doi:10.1017/S002221510600017X Printed in the United Kingdom 205