Anterolateral thigh, radial forearm and superficial circumflex iliac perforator flaps in oral reconstruction: a comparative analysis

Abstract Background Anterolateral thigh (ALT) and Radial forearm free flaps (RFFF) are historically the most common methods of oral reconstruction. The Superficial circumflex iliac artery perforator flap (SCIP) is an alternative providing a donor site that can be readily closed primarily with improved cosmesis in younger patients, due to its concealability. Methods We reviewed 135 patients who received ALT, RFFF or SCIP flaps for oral reconstruction in our institution. Our aim was to compare operative and perioperative outcomes between each cohort. ANOVA and χ 2 test were used for statistical analysis. Results There were 37 ALT, 64 RFFF and 35 SCIP reconstructions. Patients reconstructed with SCIP flaps had smaller resection volumes ( P < 0.001) and earlier T and N classifications ( P = 0.001, P = 0.008), and consequently reduced tracheostomy rates ( P < 0.001), reduced need for enteral feeding at discharge ( P < 0.001) and shorter length of stay and perioperative times ( P < 0.001). SCIP flaps were more common in younger patients ( P < 0.01). ALT flaps were used for more advanced disease ( P = 0.001) and had larger resection volumes ( P < 0.001) and increased need for assisted enteral feeding ( P < 0.001). There were no significant differences in flap or donor site outcomes. There were two flap failures, both RFFF. Conclusion Each flap plays an important role in the reconstruction of oral defects, with larger defects preferentially reconstructed with ALT flaps. SCIP appears to be a reliable alternative in small defects with excellent perioperative and postoperative outcomes.