Biodesign for Oral Tongue Defect Reconstruction: A Feasibility Study

Introduction: The resection of oral cavity cancers often creates large defects which require reconstruction. While skin grafts are often useful, they have limitations on the mobile oral tongue and have associated morbidity due to significant donor site pain and the need for a bolster which impacts post-operative speech and swallowing. Our institution utilizes a porcine small intestine submucosal allograft (Biodesign) for oral cavity mucosal reconstruction in small to intermediate-sized defects. We will describe the selection, operative management, and outcomes of 8 oral tongue defects reconstructed with Biodesign.

Methods: Patients who underwent oral tongue reconstruction with Biodesign from July 2022 to December 2023 were identified through retrospective chart review.

Results: Eight patients underwent oral tongue defect reconstruction with Biodesign, with 6 being male and an average age of 62. All surgeries addressed previously biopsied high-grade dysplasia (N=3) or squamous cell carcinoma (N=5). Defects were located in the lateral tongue (N=5), posterolateral oral tongue (N=2) or ventral tongue (N=1), with defects ranging from 7 to 28 cm². Biodesign was custom-fitted and inset with interrupted and tacking sutures through the middle of the graft to the deep muscle bed of the tongue. Drainage holes were made in the graft and no dressing was required. Four patients were admitted for observation for 1 night, all resumed oral intake within the first postoperative day. No complications were reported. Healing granulation tissue was present in the wound bed in all cases at 1 to 2 weeks after surgery. Follow-up ranged from 1 to 18 months, with functional outcomes comparable to our experience with skin grafts.

Conclusions: Biodesign presents a feasible, effective graft for small to intermediate-sized oral cavity mucosal defects. Key benefits include the absence of donor site morbidity and the elimination of bolster dressings. We also note a subjective improvement in postoperative pain and healing compared to skin grafts, warranting further objective investigation.