(33) Utility of Porcine-Derived Extracellular Matrix in Tongue Reconstruction

Abstract:
Statement of the Problem: The resection of advanced dysplastic or early-stage invasive cancers of the oral tongue could result in functional impairments, including difficulties in speech, swallowing, and taste perception, which depending on the degree of functional impairment could have a significant impact on the patient’s quality of life (QoL). Traditional reconstructive approaches, such as, autologous skin grafts, locoregional pedicled or distant free tissue transfer flaps, are effective but are invasive and associated with donor site morbidity, prolonged recovery, and longer operating room time. Therefore, the following case series presents observational findings on the use of a porcine derived small intestine submucosa (SIS) construct as an off-the shelf, non-invasive reconstructive option in partial glossectomy without donor site morbidity. Based on patient experiences and clinical impressions, we propose that SIS may offer comparable functional outcomes to traditional methods while avoiding the challenges of flap-based reconstruction.
Materials and

Methods: This observational case series includes 30 patients from September 2022 to March 2025 who underwent tongue reconstruction with porcine SIS following partial glossectomy by a single provider. Patients were followed for oncologic surveillance and assessments of speech clarity, swallowing function, pain levels, taste perception, and overall satisfaction conducted at routine follow-up visits.
Method of Data Analysis: Outcomes were evaluated through subjective clinical impressions and patient-reported feedback during follow-up visits. Thematic analysis was performed to identify trends in functional recovery and patient adaptation. No quantitative metrics or statistical analyses were applied.
Results of Investigation:
Observations and subjective self-reported patient improvements indicate that patients who underwent SIS reconstruction achieved functional recovery at least as well as those undergoing traditional flap-based procedures. Notably, the non-invasive nature of SIS appeared to contribute to smoother recovery. Unlike flap-based reconstruction, SIS implantation requires no additional donor site surgery, reducing surgical complexity and potential complications. Contrary to traditional rotation or free flaps for partial glossectomy reconstruction the near weightless SIS allows patients to function almost immediately with speech and swallow without the need for prolonged speech language therapy in the setting of a larger, bulkier flap-based reconstruction. The reduced hospital stays for patients undergoing SIS reconstruction versus a free flap was dramatically reduced as many of the patients were able to be discharged home the same day. The SIS reconstruction compared to an autologous skin graft reconstruction had no donor site morbidly as an added advantage despite both being same day surgery discharge candidates.
Outcomes Data: Our observations and experience over the last 3 years suggest that porcine SIS is a viable, less invasive alternative to traditional flap-based tongue reconstruction. The elimination of donor site surgery appears to simplify recovery, reduce morbidity, and improve patient comfort while maintaining the same functional outcomes.
Conclusions Relevant to the Problem: Based on clinical observations and patient-reported experiences, porcine SIS represents a promising reconstructive option for partial glossectomy patients. Its minimally invasive nature, combined with comparable functional outcomes to traditional flap procedures, suggests that SIS may be particularly advantageous for patients seeking a less complex, lower-morbidity alternative and are amenable to receiving allogenic porcine substrates. Our experience over the last 3 years can serve as a foundation for other surgeons around the country using our robust case series to offer this reconstructive option to their patients for reconstruction of partial glossectomy defects.




1. Membreno PV,  Eid AA,  Vanison CC,  Gillespie MB,  Gleysteen JP.  Porcine small intestine graft for reconstruction of oral defects. Laryngoscope Investigative Otolaryngology.  2021; 6(5): 940-947. https://doi.org/10.1002/lio2.626

2. Benjamin M, Aliano K, Davenport T, Frank D. Functional Outcomes Regarding Facial Artery Musculomucosal Flap for Reconstruction of Partial Glossectomy Defects. Ann Plast Surg. 2020;85(S1 Suppl 1):S76-S79. doi:10.1097/SAP.0000000000002346
Oral Squamous Cell Carcinoma Requiring Partial Glossectomy Partial Glossectomy DefectPartial Glossectomy Reconstruction with Porcine Small Intestine Submucosa