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Reconstruction after tongue removal | CION Cancer Clinics
After a glossectomy, a small gap is stitched closed or left to heal. A larger gap is filled with a flap: skin and tissue from the forearm, thigh or chest, moved into the mouth in the same operation. The flap does not move or taste, but it lets the rest of the tongue work more freely. This page explains the options, how a flap heals, and what to ask. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- How is the tongue rebuilt after part of it is removed?
- Which kinds of reconstruction are used?
- What happens to the flap as it heals?
- How do the forearm and thigh flaps compare?
- What do families believe about tongue reconstruction?
- What can this page not tell you?
- Common questions about reconstruction after glossectomy
The short answer
How is the tongue rebuilt after part of it is removed?
A small gap is simply stitched closed or left to heal. A larger gap is filled with a flap, which is skin and soft tissue taken from another part of your body, most often the inner forearm or the outer thigh, and sewn into the mouth in the same operation.
What a flap does and does not do
A flap fills the space so that the remaining tongue is not pulled tight or tied to the floor of the mouth. That lets it move more freely, which helps speech and swallowing. A flap does not move on its own, and it does not carry taste. It is a filler that the rest of the tongue works around.
Why the blood vessels matter
In a free flap, the tissue is lifted with its own small artery and vein. In the neck, these are joined to blood vessels under a microscope so the flap keeps a blood supply. This is careful, slow work, and it is the main reason reconstruction adds hours to the operation.
Who decides the type of repair
The plan is usually made before surgery by the cancer surgeon and the reconstruction surgeon together, based on the expected size of the gap. It can change in theatre if more tissue has to be removed than the scans showed. Your consent form should name the planned donor site and a backup, so ask to see both marked on your body before the day.
The options
Which kinds of reconstruction are used?
The choice depends on how big the gap is, where it sits, and your general health.
Stitching or healing on its own
For small gaps at the side or tip. No second wound, and the shortest recovery. It is not used where closing the gap would tie the tongue down.
Radial forearm free flap
Thin, soft skin from the inner forearm. It suits partial and hemiglossectomy gaps because it is supple and lets the tongue move.
Leaves
- A scar on the forearm
- A skin graft over that area
Thigh free flap
Thicker tissue from the outer thigh, known as the anterolateral thigh flap. It is used for larger gaps, including total glossectomy, where bulk is needed to fill the mouth.
Chest muscle flap
Muscle from the chest turned up into the neck, keeping its own blood supply. It needs no microscope joins, so it may be chosen when free flap surgery is not suitable.
Not sure whether this applies to you?
Ask an oncologistAfter surgery
What happens to the flap as it heals?
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The first days: flap checks
Nurses check the colour, warmth and feel of the flap often, day and night. This is the period when a problem with the blood supply is most likely, and catching it early gives the best chance of saving it.
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A possible return to theatre
If the flap looks like it is losing its blood supply, the surgeon may take you back to theatre urgently to fix the join. The team will have explained this possibility before surgery.
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Feeding and breathing tubes come out
Once swelling settles, the tracheostomy is removed and swallowing is tested. You start with sips and move on slowly with a therapist.
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The donor site heals
The forearm or thigh wound needs dressings and care. Your hand or leg will be stiff for a while, and the team will show you exercises.
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The flap settles
Over the following months the flap shrinks a little and softens. Speech and swallowing usually keep improving during this time.
Side by side
How do the forearm and thigh flaps compare?
Forearm flap
Thigh flap
Thin and pliable
Thicker, with more bulk
Usually for smaller and half-tongue gaps
Usually for larger or whole-tongue gaps
Visible forearm scar with a skin graft
Thigh scar, often closed directly and hidden by clothes
Needs a check that the hand has a good second blood supply
Thickness varies with body weight
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Commonly believed
What do families believe about tongue reconstruction?
"The new tongue will move and taste like the old one."
A flap does not move by itself or taste. It fills the space so the remaining tongue can work better. How well you speak and eat depends mostly on how much tongue is left and on therapy.
"Reconstruction is cosmetic, so we can skip it to save money."
Inside the mouth, reconstruction is about function, not looks. Leaving a large gap unrepaired can tie the tongue down and make swallowing and speech much harder.
"Taking skin from the arm will ruin the hand."
Before a forearm flap, the team checks that the hand has a second good blood supply. Stiffness and numbness near the scar are common for a while, and most people return to normal use of the hand.
"If the flap fails, nothing more can be done."
A failing flap can often be saved by an urgent return to theatre. If it cannot, the surgeon can usually use another flap from a different site.
!
One thing that cannot wait
After you go home, sudden bleeding from the mouth or neck, a neck swelling that grows quickly, or any trouble breathing needs emergency care the same day. Go to the nearest emergency department and say the person has had tongue cancer surgery with a flap. Do not wait for the next clinic appointment.
Being straight with you
What can this page not tell you?
This page cannot tell you which reconstruction you need, or whether you need one at all. That depends on the size and position of the gap, which your surgeon plans from your scans. It also cannot tell you how your speech or eating will turn out.
Who free flap surgery may not suit
A free flap means a longer anaesthetic. For people with serious heart or lung disease, poorly controlled diabetes, or damaged blood vessels from heavy smoking, the team may prefer a simpler repair. Ask how your own health affects the choice.
What to ask your centre
Ask who will do the reconstruction, and whether that team works in the same theatre as your cancer surgeon. Ask which donor site is planned and why. Ask what happens if the flap has a problem after hours, and how the flap is checked overnight.
If you smoke, tell your team honestly. Smoking narrows the small blood vessels a flap depends on, and the team can help you stop before surgery.Questions we are asked
Common questions about reconstruction after glossectomy
Is reconstruction done in the same operation?
Usually, yes. The cancer is removed and the flap is placed while you are still asleep, so you wake up with the repair already done. This makes the operation longer, but it avoids a second major anaesthetic and lets healing start straight away.
Will hair grow on the flap in my mouth?
It can, if the donor skin had hair on it. Surgeons try to choose less hairy skin. Hair often thins over time, especially if radiotherapy is given afterwards. If it bothers you, tell your team, as there are ways to deal with it.
How will I know if the flap is healthy?
In hospital, nurses check it often. At home, a healthy flap looks pink and feels warm and soft. If it turns dark, pale or cold, or the neck swells quickly, call the team the same day. Most flap problems happen in the first days, while you are still on the ward.
Will I be able to use my arm after a forearm flap?
Yes, in most cases. The arm will be dressed and rested at first, and it may be stiff or numb near the scar. A physiotherapist will give you exercises. Tell the team early if you are right-handed and the plan is to use your right arm, as they may choose the other.
Does radiotherapy afterwards damage the flap?
Flaps generally cope with radiotherapy, which is one reason they are used. The flap may shrink and firm up a little. Radiotherapy also causes dryness and soreness in the rest of the mouth, so speech and eating may slow down during treatment before improving again.
Can reconstruction be done later instead?
It is sometimes possible, but usually harder, because scar tissue and radiotherapy change the area. That is why most surgeons plan reconstruction at the same time as the cancer surgery. Ask your surgeon why they recommend one approach or the other.
Does a flap make the stay in hospital longer?
Yes. A flap needs close monitoring in the first days, and a tracheostomy and feeding tube are more likely. Your team will want to see that the flap is healthy, that you are breathing safely and that you can manage feeding before you go home.
Is reconstruction covered by Aarogyasri or insurance?
Reconstruction done as part of cancer surgery is usually covered along with the operation. Aarogyasri, CGHS, ECHS and EHS are accepted, and most cashless insurers are empanelled. Call the helpline with your card details and reports for an estimate against your cover.
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Sources
- Cancer Research UK — Mouth and oropharyngeal cancer
- NHS — Mouth cancer: treatment
- Macmillan Cancer Support — Mouth cancer
- American Cancer Society — Oral cavity and oropharyngeal cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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