Doctors from Fortis Hospital, Nagarbhavi, Bangalore successfully performed a free flap surgery (reconstruct of tongue) on a 37 year old man who was diagnosed with tongue cancer. The team of doctors led by Dr. Susheen Dutt, Consultant ENT, Head and Neck Surgeon at the Fortis Hospitals Nagarbhavi, Bangalore used the rare technique of extracting tissue from patient’s arm for this process.
The patient Bala (name changed) complained of ulcer on the tongue associated with bleeding which was not healing since three months. Initially, it was a pea sized ulcer which grew up to 3*3cms
Dr Susheen Dutt, Consultant ENT, Head and Neck Surgeon, Fortis Hospitals, Bangalore said, “Bala came to us with the complaint of ulcer on tongue which did not heal for 3 months. There was a visible growth on the tongue surface and the diagnosis is confirmed by biopsy and histopathology. The reports indicated that the patient is suffering from cancer. After a lot of team discussions, we suggested a radial forearm free flap, i.e. a tongue reconstruction surgery using tissue from his forearm.”
In radial forearm free flap surgery tissue from, arm muscle can be used to replace parts of the mouth, throat, or jawbone which are need of repair.
Speaking about the entire procedure, Dr Susheen Dutt added, “The free flap surgery is a rare process and is not commonly performed as it is time consuming and can last ten to twelve hours. In this surgery part of the tongue with cancer was removed. Soft tissue from forearm was removed with corresponding artery and vein and connected to the neck vessels. This involves delicate plastic surgery wherein forearm tissue forms the newly transplanted tongue which helps the patient eat and speak normally. We have removed the left lymph nodes from the neck to make sure cancer doesn't spread in future
Dr Athira Ramakrishnan, Consultant ENT Surgeon Fortis Hospital, said “The patient was kept under continuous observation for the next three days to ensure tissue is revitalized. He recovered within two weeks and was back to his normal life. This is one of the best onco-surgery option for tongue cancer”
As per National Institute of Cancer Prevention and Research, Oral cancer is the most common cancer in India amongst men (11.28% of all cancers), fifth most frequently occurring cancer amongst women (4.3% of all cancers) and the third most frequently occurring cancer in India amongst both men and women. Around 80% of oral cancers are directly attributable to tobacco use.
Mr Bala said, “Initially it was strange to have arm skin as tongue, but eventually I got used to it. I was suffering from stage three cancer. The replaced part doesn’t have any sensation but the existing tongue does. I regret smoking and chewing tobacco.”
The World Health Organization states that the cancer epidemic in developed countries, and increasingly in developing countries, is due to the combined effect of the ageing of populations, and the high or increasing levels of prevalence of cancer risk factors. It has been estimated that 43% of cancer deaths worldwide are due to tobacco, unhealthy diet, physical inactivity and infections. Timely diagnosis and right treatment will help bring down the rate of mortality due to cancer.
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