Clinical Efficacy of Neurorrhaphy in Anterolateral Thigh Flap Reconstruction for Tongue Cancer Defects: A Randomized Controlled Trial
In brief
Nerve-connected ALT flap improves speech, swallowing and sensation after tongue surgery
In a randomized trial of 40 hemiglossectomy patients, those receiving an ALT flap with simultaneous nerve anastomosis showed superior sensory recovery and consistently better speech and swallowing scores at 2, 6 and 12 months compared with standard ALT flaps. The functional gains translated into higher quality-of-life ratings, especially for emotional well-being and swallowing, though longer follow-up is needed.
- Journal
- Annals of surgical oncology (Q1)
- Published
- 19 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Peijing Ye, Jinhui Rao, Tao Xie, Zaihui Wang, Wenda Zhang, Dongyan He, et al.
- PMID
- 42616334
- DOI
- 10.1245/s10434-026-20302-2
Why clinicians should know about it
- Picked for Plastic and Reconstructive Surgery (top studies of the week, 11 October 2026): Neurorrhaphy improves ALT flap tongue reconstruction outcomes
Abstract
BACKGROUND: Oral cancer, particularly tongue cancer, can lead to significant functional impairments, including loss of sensation and speech and swallowing difficulties. The anterolateral thigh (ALT) flap is typically used for reconstructing tongue defects, but restoring sensory and motor functions remains challenging. Nerve anastomosis has been proposed to enhance functional recovery. METHODS: This randomized controlled trial included 40 patients who underwent hemiglossectomy and reconstruction with ALT flaps. Patients were assigned to two groups: the ALT group (n = 19), with no nerve anastomosis, and the neural anterolateral thigh flap (N-ALT) group (n = 21), with simultaneous nerve anastomosis. Functional outcomes, including sensory, speech, and swallowing assessments, were evaluated at 2, 6, and 12 months postsurgery. Quality of life (QoL) was also assessed using the University of Washington Quality of Life (UW-QoL) questionnaire. RESULTS: Compared with the ALT group, the N-ALT group showed significantly better sensory recovery, including two-point discrimination and touch pressure sensation (p < 0.05). Speech and swallowing functions were also superior in the N-ALT group at 2, 6, and 12 months after surgery. Additionally, patients in the N-ALT group had better QoL, especially in the emotional and swallowing domains. Flap volume analysis revealed less atrophy in the N-ALT group. CONCLUSIONS: Nerve anastomosis during ALT flap reconstruction for tongue cancer significantly improves sensory, speech, and swallowing functions, contributing to better postoperative quality of life. These findings support the use of nerve anastomosis as an effective strategy for enhancing functional recovery in tongue cancer reconstruction. Further long-term studies are needed to validate these benefits.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.