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#89873 02-11-2009 04:14 PM
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I'm scheduled for surgery Friday for T1N0M0 (I think) I'm new here. My second opinion doctor has a team of plastic surgeons who are recommenging that we be aggressive with the tongue and rebuild with a forearm free flap.

First, I'm not thrilled about anyone touching my veins or arteries so I have to clarify that part and secondly, it's going to bad enough that I'm getting a neck dissection. Do they have to touch my arm too?

Anyone had this procedure done or just a regular skin graph. Is one better than the other?


SCC T1N0M0 Floor of mouth (under tongue) - Surgery 2-13-09. Forearm free flap with partial glassectomy and left neck dissection. Clean margins and nodes! Contemplating radiation. Non-smoker/casual wine drinker
partovis #89876 02-11-2009 04:38 PM
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I can't answer your question, but I want to wish you the best with your surgery and tell you that you are among a very supportive and knowledgeable group here, many of whom will be able to answer your questions, and they will come.
Here's to a good surgery and speedy and uneventful recovery.

Marlene


Marginal mandibulectomy 6/17/08 resulted in DX of Stage I SCC - gingiva (3 mm) right mandible, buccal side. Clear margins. Occasional social drinker. Smoked last cigarette in 1979. Clear pet: 12/08; 7/20/09. Yay!
partovis #89877 02-11-2009 04:39 PM
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Where is your tumor located? Is this at a CCC or just a doctor's office or hospital? You say that this is a second opinion, what caused you to request a second opinion? How old are you?

You have found a good location for answers and support here. You can search both the forums and the entire site for subjects such as "forearm free flap".

I have had a skin graft for cancer in the floor of my mouth, a neck dissection and a free flap from my pectoral muscle for cancer in my tongue. Whether one is better than the other is really not the question - it is more a question of which treatment is best for your situation and which treatment are you most comfortable with?

Try to take a deep breath and hopefully you will get some insight here into different treatments.

Patty


48
SCC Floor of Mouth 7/06
9/06 Surgery, bilateral neck dissection, 58 nodes clear PT2pN0pMx
35 rad 2006
Recurred 6/08, 1 Carboplatin, 1 Cisplatin
Surgery 9/08 - Total glossectomy, free flap from pectoral muscle, left mandible replaced using fibula
35 IMRT & Erbitux 11/08
4/15/09 recurrence
6/1/09 passed away, rest in peace
partovis #89880 02-11-2009 06:43 PM
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Hi! I had a forearm free flap to rebuild my tongue. The procedure also included a skin graph from my thigh to cover the hole left in my wrist. I don't know about a skin graph for the tongue, that wasn't offered as an option. What I can tell you, is that the flap makes it possible for me to speak and eat 'normally.' Every thing is a little bit slo-o-o-wer, but overall, I'm very pleased with my results.


Stage IV SCC lt lateral tongue, surgery 5/19/08 (partial gloss/upper neck dissection left side/radial free flap reconstruction) IMRT w/weekly Cisplatin & Erbitux 6/30/08, PEG 1 6/12/08 - out 7/14 (in abdominal wall, not stomach), PEG 2 7/23/08 - out 11/20/08, Tx done 8/18/08
Second SCC tumor, Stage 1, rt mobile tongue, removed 10/18/2016, right neck dissection 12/9/2016
Third SCC tumor, diagnosed, 4/19/2108, rt submandibular mass, HPV-, IMRT w/ weekly Cisplatin, 5/9 - 6/25/2018, PEG 3 5/31/2018
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I also had the forearem free flap. Graph from my leg to cover the arm. I am now almost a year and a half out from treatment. I can speak very close to normally. It is still hard to chew some things, but can eat close to normally. I think it would be even better if I had saliva. Still hasn't come back from radiation. I too am pleased with the results as said in the previous post. My surgeon also said to be aggresive. We were going for the cure. Just remember to take one step at a time. Things really do get better, it just may take a little longer than you had hoped. I really live just about like I did before the big C hit my life.


SCC of tongue removed 3/07 mod. left neck dissection. Tumor reappeared 6/07. Removed 8/07, right neck dissection, free flap from wrist for tongue graph. Radiation 30 (IMRT), chemo cisplatin 4 rounds finished 11/07.
Good1 #89892 02-11-2009 08:57 PM
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SCC lower floor of mouth. Tumor is lower mid tongue area. I'm 39 years old.

I was first referred to a cancer center and the doctor recommended surgery and left and right neck dissection. Skin graph from thigh with bolster technique.

Second doctor is with a good hospital. He recommended the above (left neck dessection) with removing the tumor and a forearm free flap to rebuild the tongue.

My tumor is a T1 and boardering T2. Leaning towards second doctor and have the surgery already scheduled for this Friday...I'm just not sold on the forearm free flap. I'm wondering if thigh graph with lots of physically therapy will have the same effect.

Thanks for all of the quick responses!


SCC T1N0M0 Floor of mouth (under tongue) - Surgery 2-13-09. Forearm free flap with partial glassectomy and left neck dissection. Clean margins and nodes! Contemplating radiation. Non-smoker/casual wine drinker
partovis #89893 02-11-2009 09:08 PM
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What part of the free flap are you questioning?

Ack, I re-read your initial post and see the vein/artery part is off-putting. My thoughts, for whatever they're worth...

If you're only 39 and your cancer is cured, you've got a lot of years ahead of you. Would you be happy with anything less than the best the docs can do for you? Will you be satisfied with that for the next 30 or 40 years? Honestly, I don't miss the vein and artery in my right arm. And the trade off is a very, very workable tongue. The scar on my arm is still pretty nasty looking, although friends tell me it isn't all that bad, but what I gained was a tongue that will work for me for a long time to come.

Last edited by margaret_in_ma; 02-11-2009 09:17 PM.

Stage IV SCC lt lateral tongue, surgery 5/19/08 (partial gloss/upper neck dissection left side/radial free flap reconstruction) IMRT w/weekly Cisplatin & Erbitux 6/30/08, PEG 1 6/12/08 - out 7/14 (in abdominal wall, not stomach), PEG 2 7/23/08 - out 11/20/08, Tx done 8/18/08
Second SCC tumor, Stage 1, rt mobile tongue, removed 10/18/2016, right neck dissection 12/9/2016
Third SCC tumor, diagnosed, 4/19/2108, rt submandibular mass, HPV-, IMRT w/ weekly Cisplatin, 5/9 - 6/25/2018, PEG 3 5/31/2018
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I've had the forearm free-flap and graft from my thigh to cover my wrist, and I'm doing fine with it. I also had a layer of integra put down under my graft to keep my graft from sticking to the tendons in my arm (but I've yet to find anyone else who had this done). My graft to cover my wrist was done in a separate surgery about a month after they took the flap to allow the integra to take and I had a wound vac put over it in between the surgeries (some kind of new fandangled negative pressure stuff). Yeah, the scar is pretty noticeable on my arm, but it's worth the trade - and it's fading a lot now. The only thing I notice with not having the artery in my arm is that the small area of skin that the artery was located under gets cold and the veins in my arm show up more than they used to. That's it, other than that, I exercise and lift weights and do things normally with my arm - I haven't tried cartwheels or handstands yet, but that is coming soon I'm sure.


Stephanie, 23, SCC on the right side of my tongue, surgery on 5-19-08, over half my tongue removed, free flap constructed from my forearm, bilateral neck dissection, one positive node. Radiation (32) and chemo (carboplatin) started on 6-16-08. Recurrence 4/09 in lungs.

**** Stephanie passed away 12.15.09.... RIP our dear friend****


sobradley #89897 02-11-2009 11:51 PM
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I see the free flap work as separate from the actual cancer work, so the term "aggressive" seems a bit out of place here. Maybe some sort of synthetic hole filler would be considered less aggressive? Or should we be using the word invasive...

I don't know of any case where just a skin graft has been used -- Seems to me that would be a waste of time -- One could easily get by with a tongue smaller than the thickness of a graft, and a graft would not 'back fill' a larger portion of missing tongue.

The purpose of the flap is to fill in on the tongue when there is not much left, especially in the oral or mobile tongue (front part). My first partial glossectomy surgeries didn't involve flaps because there was plenty of working tongue left after the tumor was removed and good margins obtained.

My next glossectomy removed so much of the front of my mobile tongue that something was needed to fill the hole to avoid food and air currents (as in speech)from being trapped there. The flap was constructed using tissue from my forearm, plus the veins and arteries needed to keep the tissue alive (spliced into neck veins and arteries for blood supply). BTW, remaining blood vessels will expand to meet the situation (aka collateral growth) and grow new paths as needed, so over time that isn't going to be a problem.

Gonna do a flap, have to mess with veins and arteries or you might as well make something out of an old shoe to stick in there. Not at all sure why that would be a problem -- The ability to splice all these blood vessels together under a microscope is the basis for being able to do the flaps in the first place.

The thigh graft (not graph) is almost an after-thought in the whole process, being just the removal of a layer of skin from my thigh to cover the forearm because all the surface skin was now in my mouth -- They even left the hair behind. I just looked at my thigh and I can hardly tell where they harvested the graft. My friend was looking at my wrist donor site a few days ago and remarked that it wasn't very noticeable any longer, with the scars and color matching the surrounding skin (but it is missing hair, the original hair went into my mouth and the graft hair was left behind on my thigh).

However, with the discovery of more cancer on BOT and the subsequent total glossectomy that went with correcting that, a much larger free flap donor site was needed for the new flap than my other wrist could provide, so they chose to get the flap material from my other thigh. No graft involved because they just pulled the edges of the donor area together and stapled them.

Subsequent failure of some of that flap from lack of adequate blood flow (as evidenced by pin pricks on the flap for the first week after surgery) shows the need for messing with veins and arteries.

Last edited by Pete D; 02-11-2009 11:59 PM.

Age 67 1/2
Ventral Tongue SCC T2N0M0G1 10/05
Anterior Tongue SCC T2N0M0G2 6/08
Base of Tongue SCC T2N0M0G2 12/08
Three partial glossectomy (10/05,11/05,6/08), PEG, 37 XRT 66.6 Gy 1/06
Neck dissection, trach, PEG & forearm free flap (6/08)
Total glossectomy, trach, PEG & thigh free flap (12/08)
On August 21, 2010 at 9:20 am, Pete went off to play with the ratties in the sky.
Pete D #89908 02-12-2009 06:52 AM
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I would still try to get another opinion from a CCC. Here's the link:

http://www.oralcancerfoundation.org/resources/cancer_centers.htm

I got 5 different opinions before I was fortunate to find Moffitt.


David

Age 58 at Dx, HPV16+ SCC, Stage IV BOT+2 nodes, non smoker, casual drinker, exercise nut, Cisplatin x 3 & concurrent IMRT x 35,(70 Gy), no surgery, no Peg, Tx at Moffitt over Aug 06. Jun 07, back to riding my bike 100 miles a wk. Now doing 12 Spin classes and 60 outdoor miles per wk. Nov 13 completed Hilly Century ride for Cancer, 104 miles, 1st Place in my age group. Apr 2014 & 15, Spun for 9 straight hrs to raise $$ for YMCA's Livestrong Program. Certified Spin Instructor Jun 2014.
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