Comparative assessment of early surgical recovery and functional outcomes following anterolateral thigh and radial forearm free flap reconstruction for oral soft-tissue defects in a tertiary care centre

Amir Mohamed; Rolanda Saint Louis; Princess Merem; Shehla Ashraf; Charunmayi Lakshmi Brahmani Adari

doi:10.18203/2349-2902.isj20263850

Authors

Amir Mohamed Elrazi University, Khartoum, Sudan
Rolanda Saint Louis Washington University of Health and Science, San Pedro, Belize
Princess Merem International University of the Health Sciences (IUHS), School of Medicine, Winnipeg, Canada
Shehla Ashraf Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India
Charunmayi Lakshmi Brahmani Adari Government Medical College, Srikakulam, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2349-2902.isj20263850

Keywords:

Anterolateral thigh free flap, Radial forearm free flap, Oral cavity reconstruction, Soft-tissue defects, Flap survival, Donor-site morbidity

Abstract

Background: Reconstruction of oral cavity soft-tissue defects following oncological resection is essential for restoration of oral function and minimization of donor-site morbidity. Anterolateral thigh free flap (ALTFF) and radial forearm free flap (RFFF) are commonly used reconstructive options. This study compared their early surgical and functional outcomes.

Methods: A prospective observational study was conducted in the Department of Plastic Surgery, King George Hospital, Visakhapatnam, from May 2025 to April 2026. Fifty patients requiring free-flap reconstruction of oral cavity defects were included. Twenty-eight patients underwent ALTFF reconstruction and 22 underwent RFFF reconstruction. Flap survival, defect and flap dimensions, donor-site complications, and postoperative mouth opening were assessed.

Results: The mean age was 54.64±8.89 years, and 60% of patients were female. ALTFF was used in 56% and RFFF in 44% of cases. Mean defect and flap surface areas were significantly greater with ALTFF than RFFF (61.53±19.51 vs 42.22±10.77 cm², p=0.0001; 138.62±42.26 vs. 74.46±15.89 cm², p<0.0001). Flap survival was 89.3% with ALTFF and 86.4% with RFFF. RFFF donor-site graft loss occurred in 40.9% of cases. Mean mouth opening improved from 4.15±1.15 cm preoperatively to 4.71±0.58 cm postoperatively.

Conclusions: Both ALTFF and RFFF provided satisfactory early surgical and functional outcomes. ALTFF facilitated reconstruction of larger defects with lower donor-site morbidity, while RFFF provided reliable reconstruction with acceptable functional outcomes. Flap selection should be individualized according to defect characteristics and tissue requirements.

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