Extensive and delayed necrosis of a free flap following subtotal glossectomy and adjuvant radiotherapy

Abstract

Oral tongue squamous cell carcinoma is the most common malignancy of the oral cavity. Treatment of this tumor is based on surgical removal with a centimeter margin, which can be combined with radiotherapy. This case report details a late necrosis of an anterolateral thigh flap used for oncological reconstruction of a subtotal glossectomy requiring comprehensive management. A 61-year-old patient, with no medical history, was treated for a large squamous cell carcinoma with subtotal glossectomy combined with adjuvant radiotherapy. During radiotherapy, radiomucositis appeared on the lateral sides of the flap. The ulcerations continued to progress for several months after the end of treatment, eventually leading to complete necrosis of two-thirds of the flap three months after radiotherapy Our findings suggest that late septic necrosis can develop on severe radiomucositis in patients without significant comorbidities or traditional risk factors. This evolution may also suggest an intrinsic radiosensitivity of the patient.