Optimizing Flap Measurements for Tongue Reconstruction: Harnessing the Power of the Pythagorean Formula

Head and neck reconstruction, particularly tongue reconstruction, remains a formidable challenge. However, crafting a three-dimensional structure from a basic flap necessitates precise dimensions to avoid excess or insufficiency. At the same time, the tongue also has to be accommodated inside the oral cavity to prevent protrusion or repeated injuries due to tooth bites. This study aims to showcase the practicality of employing Pythagoras's formula in both preoperative and intraoperative settings to the required flap dimensions for partial and hemiglossectomy tongue defects. Between 2020 and 2022, we have undertaken 53 tongue reconstructions to address defects resulting from partial or hemiglossectomies. Among these cases, 51 were managed with free radial artery flaps, while in two we utilized anterolateral thigh flaps for reconstruction. Our study excluded cases involving minor tongue defects amenable to primary closure. By treating the length of the tongue defect as the hypotenuse, Pythagoras's formula is applied to calculate the optimal length and width of a free microvascular flap. The tongue reconstruction is performed, and microvascular anastomosis is carried out in the neck. An addition was made for associated buccal mucosa defects, if any. All flaps survived without any complications like bleeding, wound dehiscence, and partial or complete flap necrosis. Tongue movement was adequate, with good swallowing and good speech. The application of Pythagoras's formula provides a dependable method for determining flap size pre- and intraoperatively in cases of partial or hemiglossectomy tongue defects, leading to favorable functional and aesthetic results.