Bilateral Tunnelized FAMM Islanded Flap for Reconstruction of Composite Defect of Tongue and Floor of Mouth: A Case Report.

The work of Massarelli et al. is well known for popularizing t-FAMMIF, however to the best of our knowledge bilateral flap has never been harvested and inset together to reconstruct a composite defect. Larger unilateral flaps have been reported in literature but to harvest such a flap in patients of S.E Asian region would entail high propensity for trismus in the post op period as they have tendency for submucosal fibrosis owing to their guthka (chewing tobacco) chewing habits. Oral submucous fibrosis is contra-indication for this flap; however, some of our patients despite being chronic abusers of guthka do not have clinical presentation of OSMF and if the defect post ablation is appropriate are chosen to be candidates for reconstruction with the flap. In this select population harvesting larger flaps can potentially lead to trismus, a fact highlighted in the paper.