Using skin grafts to help rebuild tongues after surgery

More than 10,000 Americans are diagnosed with tongue cancer each year, some requiring surgery to remove the cancerous part of their tongues.

Although surgery to remove the cancerous part of the tongue can save lives, it can also leave some people unable to talk or eat. One doctor is now using skin and fat from a patient's arm to rebuild tongues, as well as lives.

Getting her children out the door and to school is a daily mission for mother Lisa Bourdon-Krause, but it is one she does not take for granted. A few years ago, Bourdon-Krause was diagnosed with tongue cancer.

"They said surgery would be the best option," said Bourdon-Krause.

Surgery would mean removing half of Bourdon-Krause’s tongue. One of her doctors told her she might not ever talk again and, at the time, her son was only two.

Not knowing if her son would ever hear his mother’s voice again, Bourdon-Krause recorded herself.

“I started to try to think of everything I would ever want to say to him," said Bourdon-Krause.

But thanks to a surgeon, she never had to give her son those recordings.

"It's just everything that you do, and it's just so much of your identity," said Douglas B. Chepeha, doctor at the University of Michigan Medical School's Department of Otolaryngology Head and Neck Surgery.

In a 10-hour surgery, surgeons cut out the cancerous part of Bourdon-Krause’s tongue. Then, Chepeha took skin from Bourdon-Krause’s own forearm and attached it to her tongue, using a pattern as a guide. The result: a tongue that looked and felt much like the real thing.

"What I'm really doing is I’m putting in tissue from another part of their body to help the tissue that they have left work," said Chepeha.

Bourdon-Krause was able to talk a few days after her surgery and, after a couple of weeks, she could eat. It was a relief, but not the biggest one for Bourdon-Krause.

"None of it scared me though because all I cared about was living," said Bourdon-Krause. “All I cared about was being alive."

Now, she's grateful for every moment and every word she can speak.

Chepeha said the forearm is usually a good place to take a skin graft because it has thick tissue that sits right beside thin tissue, which is similar to how the tongue is constructed. He went on to say that a benefit to this procedure is patients do not have to take anti-rejection drugs because the transplanted skin is their own.

Research Summary:

BACKGROUND: According to the Mayo Clinic, tongue cancer is a serious type of head and neck cancer. It usually appears as squamous cells (a lump, white spot or ulcer) on the outer layer of the tongue. When it's caught early, tongue cancer is highly curable. When the cancer forms in the front two-thirds of the tongue, it is classified as "oral tongue cancer." When it develops in the remaining third of the tongue it is classified as "tongue base cancer" and is considered a form of throat cancer.
People with a history of smoking and alcohol dependence have a greater risk for developing this type of cancer. More than 10,000 Americans are diagnosed with tongue cancer each year.

TREATMENT: Treatment for tongue cancer typically depends on the type and stage of the cancer. Oral tongue cancer is usually treated with surgery and is often followed by radiation therapy. Tongue base cancer is often treated with a combination of chemotherapy and radiation therapy and is sometimes followed by surgery.

EFFECTS OF SURGERY: Sometimes, surgeons have to remove a large portion of the tongue when they cut out the cancer. This can affect a person's speech and ability to eat and swallow. Some patients that can speak after surgery are not comfortable doing so in public. "Patients were really limiting their social activities," Douglas Chepeha, M.D., M.S.P.H., from the University of Michigan Medical School, told Ivanhoe. "They would often say they did things that they really couldn't do."

REBUILDING TONGUES: Dr. Chepeha and his team have developed several techniques for reconstructing tongues. They use innovative patterns, which are much like dress patterns, to help them determine the size and shape of the skin tissue they'll cut for transplanting. The tissue is taken from another part of the patient's body (often the forearm), so there isn't a risk of rejection. The procedure typically involves removing a portion of the tongue and reconstructing a new tongue. It requires surgeons to dissect and reattach blood vessels. The vessels are sewn together with tiny sutures. The result is a tongue that is not a muscular organ but looks and feels much like the real thing. "In the past, patients who have undergone tongue reconstruction would be very concerned about social interaction," Dr. Chepeha was quoted as saying in a University of Michigan press release. "With the type of reconstruction we're performing now, our patients tell us that they're willing to go into a restaurant and order a meal. They have no hesitation whatsoever in asking strangers for directions. They are also able to maintain their employment status and their interactions with family and friends."

FOR MORE INFORMATION, PLEASE CONTACT:
University of Michigan Cancer AnswerLine
Ann Arbor, MI
(800) 865-1125


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