Radial Forearm Free Flap Reconstruction Research Articles

A retrospective propensity score-matched analysis of oncological and functional outcomes of submental island flap versus radial forearm free flap for oral cavity cancer reconstruction

BackgroundThis retrospective study aims to compare the oncological and functional outcomes of the submental island flap versus the radial forearm free flap used for oral cavity cancer reconstruction after minimizing differences in baseline characteristics.MethodsPropensity scores for each oral cavity cancer patient who underwent surgical resection and immediate reconstruction with a submental island flap or a radial forearm free flap with a flap size ≤ 60 cm2 between October 2008 and December 2021 were generated based on the likelihood of being selected given their baseline characteristics. Patients were matched using a 1:1 nearest-neighbor approach.ResultsThe final matched-pair analysis included 51 patients in each group. The 5-year overall survival, disease-specific survival, and locoregional control rates were 70.1% and 64.8% (p = 0.612), 77.3% and 83.7% (p = 0.857), and 76.1% and 73.3% (p = 0.664), respectively, for the submental island flap group and the radial forearm free flap group. Speech and swallowing functions were comparable between groups. However, there were significantly lower rates of complication associated with both donor and recipient sites in the submental island flap group, and also the duration of hospital stays and hospital costs were significantly lower in these patients. A subgroup analysis of patients in which the reconstruction was carried out using the submental island flap procedure revealed that in selected cases, the presence of clinically and pathologically positive level I lymph nodes did not affect survival or locoregional control rates.ConclusionsAlthough this study was not randomized, the matched-pair analysis of surgically treated oral cavity cancer patients showed that submental island flap reconstruction is as effective as radial forearm free flap reconstruction with regard to oncological and functional outcomes with lower complication rates, hospital stay, and hospital costs. This flap can be safely and effectively performed in selected cases with a clinical level I lymph node smaller than 1.5 cm and no signs of extranodal extension.

Volumetric changes in post hemiglossectomy reconstruction with anterolateral thigh free flap versus radial forearm free flap

The volume of the reconstructed tongue is considered a critical factor for tongue function. Studies investigating the difference in volume loss between the anterolateral thigh free flap (ALTF) and radial forearm free flap (RFFF) used in reconstruction of the tongue after hemiglossectomy are lacking. The aim of this study was to determine whether there is a significant difference in shrinkage between these two flaps. This was a retrospective study of all patients treated for tongue cancer by hemiglossectomy who underwent either ALTF or RFFF reconstruction at the University of Florida College of Medicine between January 2018 and April 2022. Computed tomography scans were used to measure the volumetric changes in the ALTF and RFFF at two time points over a 6-month period. Of the 85 patients assessed, 10 fulfilled the inclusion criteria: five were reconstructed with an ALTF and five with a RFFF. All underwent adjuvant radiotherapy. The mean ALTF percentage shrinkage was 39.6% ± 3.9%, while for the RFFF it was 51.1% ± 6.2% (P = 0.008). Therefore, it is recommended that the difference in volume loss between the two flaps is taken into consideration. It is suggested that in hemiglossectomy cases, the ALTF is made 1.4 times larger than the defect, while the RFFF is made 1.5 times larger.

Clinical, functional, and patient-reported outcomes of radial forearm versus anterolateral thigh free tissue transfer for reconstruction of glossectomy defects.

There is a lack of literature of health-related quality of life endpoints for radial forearm (RF) versus anterolateral thigh (ALT) free flap reconstruction for glossectomy defects. Our goal was to perform a comprehensive evaluation of clinical, functional, and quality of life outcomes after glossectomy reconstruction using a RF or ALT flap. A retrospective review was performed on patients who underwent glossectomy and immediate reconstruction with RF or ALT flaps between 2016 and 2021. Outcomes of interest included readmission and reoperation rates, functional assessments, tracheostomy and gastrostomy tube status, and FACE-Q Head and Neck Cancer scores. Seventy-eight patients consisting of 54 RF and 24 ALT free flaps were included. ALT patients had a larger median flap size (72 vs. 48 cm2 , p = 0.021) and underwent mandibulotomy (50% vs. 7.4%, p < 0.0001) and base of tongue resection (58.3% vs. 24.1%, p = 0.005) at higher rates. No significant differences were found with respect to other outcomes. The RF and ALT flaps are suitable for glossectomy reconstruction, with minimal differences seen in postoperative outcomes. Our study suggests that ALT can be used in patients with base of tongue and larger defect sizes, while providing similar functional and clinical outcomes to RF reconstruction.

Mandible Reconstruction in a Rural Population: Comparison of Radial Forearm and Free Fibula Flap Outcomes.

Comparison of microsurgical reconstructive options after mandible resection is limited in the literature. Fibula free flaps (FFFs) can be costly and have timing limitations, but dental restoration can be performed, with varied reported rates of completion. The radial forearm free flap (RFFF) with mandible plating may be an alternative in select populations. The purpose of this study was to determine if the RFFF has similar outcomes to the FFF for mandible reconstruction in a rural population. A retrospective review of patients who underwent mandibulectomy from 2017 to 2021 at a single tertiary-care academic institution was performed. Those with FFF or RFFF reconstruction were included. Mandible defects were classified using the Jewer-Boyd H-C-L system. Sixty-eight patients were included with 53 undergoing FFF and 15 undergoing RFFF. Immediate reconstruction was significantly more common with RFFF than FFF (100% versus 64.2%; P =0.01). Lateral mandible defects were most common among both groups (52.9% FFF versus 73.3% RFFF; P =0.04). Osseous defect length was similar (9.5cm FFF versus 7.7cm RFFF; P =0.07), but soft tissue defect size was significantly larger in the RFFF group (28.6cm 2 versus 15.3cm 2 ; P =0.01). Complication rates (47.1% FFF versus 46.7% RFFF; P =0.98) and disease-free status at last follow-up (96.2% FFF versus 80.0% RFFF; P =0.06) were similar. Dental restoration occurred in 21.3% of patients undergoing FFF. Patients undergoing RFFF or FFF reconstruction after mandibulectomy had similar surgical and disease outcomes, with a low rate of completed dental restoration after FFF. Our findings suggest RFFF is a reasonable alternative to FFF for mandible reconstruction in select patients.

Radially Pedicled In-Situ Split-Thickness Skin Grafts, an Alternative to Distal Split-Thickness Skin Grafts.

This study aimed to introduce a novel radially pedicled in-situ split-thickness skin graft (STSG). The morbidity, esthetic, and functional outcomes of the radially pedicled in-situ STSG were in comparison with those of the distal STSG. Retrospective analysis. A single-institution review. Seventy patients with oral cancer who underwent radical surgical resection and simultaneous radial forearm free flap (RFFF) reconstruction from July 2021 to March 2022 were included. De-epithelialized RFFFs and traditional RFFFs were used to repair oral defects of 35 patients in Group A and Group B, respectively, while radially pedicled in-situ STSGs and distal STSGs taken from abdomens were used to repair donor site defects in the above groups, respectively. Patient demographics, wound healing complications, and esthetic and functional outcomes of the forearms were compared between the 2 groups. No significant difference between Group A and Group B was observed in terms of donor site and recipient site complications. The esthetic outcome was superior in Group A compared to Group B (P = .011). The extension range, sensation, and pinch strength of operated forearms were significantly reduced in both groups after surgery (P < .05), however, intergroup differences were not observed. Taken together, our results suggest that radially pedicled in-situ STSG is an applicable technique for direct closure and better esthetic outcomes in the forearm donor site.

Airway Fire During Tracheostomy

Introduction Airway fire is a life-threatening complication in the operation table which is preventable. We report an incident of airway fire that occurred during a tracheostomy and discuss what went wrong. Case report A 48-year-old gentleman with carcinoma tongue and multinodular goiter underwent modified radical neck dissection, hemithyroidectomy, tracheostomy, hemi glossectomy, and free radial forearm flap reconstruction. During tracheal hemostasis with cautery, a flame appeared, and airway burns resulted. It was extinguished in a few seconds with wet mops, but the resultant combustion injury of the tracheobronchial tree and later bilateral pneumonia required multiple sittings of bronchoscopic toileting and intensive airway management for recovery. Discussion This report is to make anesthetists and surgeons aware of such a rare but life-threatening complication, its prevention, and early therapeutic steps which can prevent long-term complications and death.

Management of radial forearm free flap failure in head and neck reconstruction due to COVID-19 infection

Free flap surgery is a largely diffuse technique that allow to reconstruct various complex tissue defects. In head and neck surgery, they allowed reconstruction of an important variety of defects such extensive resection in treatment of malignant and benign tumors, defects as trauma consequence, congenital defects, and others. We present the case of 69-year-old Caucasian male admitted to the Department of Head and Neck for a cT2 N2b M0 squamous cell carcinoma of oral cave extended to the oral pharynx and treated with extended resection and radial forearm free flap reconstruction. No early postsurgery complication was detected. After 10 days from surgery, patient resulted positive for SARS-CoV-2. In the days after positivization, free flap started to show signs of ischemia, which lead to necrosis flap itself. A second surgery with palatal rotation flap and Bichat fat pad flap was necessary. Failure of free flap reconstruction is associated to vascular failure. In particular, venous thrombosis is the most common cause of vascular failure. Anterolateral thigh free flap was the one associated with the highest incidence of complications. Clinical comorbidity, smoking, age, and surgeon experience have been described as the mean risk factors. Actual knowledge as confirmed an increased risk of venous and arterial thromboembolic events in patients with SARS-CoV-2 infections. Nowadays there is no evidence of a correlation between SARS-CoV-2 diseases and free flap failure. Our case, about the patient with a tardive vascular free flap failure consequent to SARS-CoV-2 infection, suggests how COVID-19 could be a new risk factor for reconstructive surgery that surgeon community must keep in mind.

D49. Patient Reported and Clinical Outcomes after Radial Forearm vs. anterolateral Thigh Free Flap Reconstruction of Glossectomy Defects: A Preliminary Examination

PURPOSE: Patient reported outcome measures such as FACE-Q, are currently being integrated and evaluated in head and neck reconstruction. This study examines clinical and FACE-Q outcomes in patients that underwent oncologic glossectomy reconstruction with radial forearm (RFFF) vs. anterolateral thigh (ALT) free flaps. METHODS: A retrospective review was performed for patients who underwent partial or hemiglossectomy and primary reconstruction with a RFFF or ALT between 2016-2021. FACE-Q is separated into multiple functional and stress domains where higher scores (0-100) represent better outcomes. Postoperative FACE-Q scores were divided into two time periods for comparison: short-term (0-1 year) and long-term (>1 year). The rate of complications that necessitated return to OR was also examined. RESULTS: 88 patients underwent partial or hemiglossectomy reconstruction with a RFFF, while 43 received an ALT. 56 RFFF and 16 ALT patients filled out at least one postoperative FACE-Q. RFFF patients reported significantly higher short-term satisfaction with their smile (p=0.017) and swallowing function (p=0.048). This cohort also reported significantly better long-term satisfaction with facial appearance (p=0.002), function in eating/drinking (p=0.014), and oral competence (p=0.016), as well as significantly less distress with eating (p=0.005) and facial appearance (p=0.014). There was no significant difference in complication rates between the two cohorts. CONCLUSION: The RFFF may perform better than the ALT in multiple PROM domains after reconstruction of glossectomy defects in the short and long-term. Expansion of this study may provide useful information for shared decision making between patients and providers in head and neck reconstruction moving forward.

Robot-assisted radial forearm free flap harvesting: a propensity score-matched case-control study.

Although some surgeons prefer anterolateral thigh and latissimus dorsi flap for soft tissue reconstruction in the head and neck area because it minimizes donor site complications, the radial forearm flap remains the workhorse for soft tissue reconstruction due to its reliability. To reduce donor site morbidity, the authors developed a novel technique for radial forearm flap harvesting using a robotic device. 42 radial forearm free flap reconstruction cases were studied, consisting of 31 conventional and 11 robot-assisted cases. 1:1 propensity score matching was done according to age, sex, previous and postoperative radiation therapy history and method used for vein anastomosis. There was no significant difference in flap outcome, which was 100% vitality in the robot-assisted group and 90.9% vitality in the conventional group. The robot-assisted group showed significantly longer mean harvesting time than did the conventional group, being 107.2min and 67.0min, respectively. Robot-assisted radial forearm flap harvesting can reduce donor site complications by minimizing incision. When more surgical experience is gained under appropriate case selection, we expect our robot-assisted method will yield a harvesting time similar to that of the conventional method and thus become more reliable and feasible.

Tissue Transfer After Tongue Resection: Micro-Vascular Reconstruction Using Radial Artery Free Flap versus Reconstruction by Split Thickness Skin Graft in T2 Lesions of Tongue Carcinoma.

To compare postoperative complications, functional rehabilitation, surgical outcomes of the radial artery forearm free flap (RAFFF) and split thickness skin graft (STSG) reconstruction of postsurgical defect in T2 lesions of cancer oral cavity. Observational Prospective comparative study. Academic tertiary referral centre. In our study of forty four patients, after tumour resection, half underwent reconstruction using RAFFF (Group I) and another half by STSG (Group II). All of the patients were followed postoperatively to determine and compare their functional outcomes related to donor site and recipient site complications, speech, deglutition and mouth opening. The speech intelligibility and deglutition were each assessed using Articulation Handicap Index and Vedio-fluoroscopy using the Functional oral intake scale. Operative time for STSG reconstruction was shorter at 2.2 ± 0.97 SD hours compared to 5.9 ± 1.24 SD hours for RAFFF reconstruction. Hospital stay was 8.3 ± 1.19 SD days for STSG patients and 12.6 ± 1.7 SD days for RAFFF patients. Thefunctional outcomes of speech quality and swallowing were near comparable in both groups but the donor site complications were significant in theRAFFF group. Operative time, hospital stay anddonor site complications are both significantly reduced with the STSG as opposed to RAFF. Functional and oncologic results of both methods are near comparable. To conclude, STSG can be used for reconstruction of thepost-surgical defects in T2 lesions of thetongue.

Neuropathic Donor-Site Pain following Radial Forearm Free Flap Harvest: A Multicenter Study on Incidence, Prognostic Factors, and Quality of Life.

The radial forearm free flap (RFFF) is widely used and is considered one of the workhorse flaps in oncologic head and neck reconstructions. However, the potential for significant donor-site morbidity remains a major drawback. Although various donor-site problems have been reported, the incidence of neuropathic pain and possible predicting factors remain unclear. This study aimed to identify the incidence, prognostic factors, and impact on quality of life of neuropathic pain following RFFF harvest. In this multicenter, cross-sectional study, 167 patients who underwent an RFFF reconstruction between 2010 and 2020 were included. Baseline characteristics were collected by medical charts. All patients received questionnaires to measure patient's pain (Doleur Neuropathique 4 and visual analog scale, pain), hand function (Patient-Reported Wrist and Hand Evaluation), and quality of life (EuroQol 5D). Multiple logistic regression was used to identify prognostic factors associated with outcomes. A total of 114 patients (68%) completed the questionnaire. Neuropathic pain was present in 18% of all patients. Donor-site wound problems, mostly tendon exposure, occurred in 32% and was significantly correlated with neuropathic pain (p = 0.003). Neuropathic pain was significantly associated with poorer quality of life (p < 0.001) and poorer hand function (p < 0.001). Almost one-fifth of all patients deal with neuropathic pain following RFFF harvest. Neuropathic pain is significantly correlated with poorer hand function and a poorer quality of life. Therefore, future research should focus on analyzing surgical factors such as the management of wound problems and primary denervation to improve hand function and quality of life of these patients.

Vascularised periosteal free flap reconstruction for medication-related osteonecrosis of the jaw: a case series

Introduction: The standard of care for medication-related osteonecrosis of the jaw (MRONJ) involves anti-biotics and local debridement to promote tissue healing over exposed bone. We compare outcomes for patients with advanced MRONJ managed with vascularised periosteal radial forearm free flap (RFFF) ver-sus local nasolabial flap and conservative dental measures. Methods: A retrospective case series of patients presenting to the Alfred Hospital for evaluation and man-agement of stage II or above MRONJ between 1 January 2014 and 30 June 2018. The hospital database was searched And a medical record review performed. Results of pre- and post-treatment imaging were ana-lysed bya single senior radiologist blinded to treatment modality . Asymptomatic wound closure, radio-logical evidence of disease cessation and patient satisfaction at six months post-treatment according to treatment type were assessed. Results: Of the ten patients included in the study, four received dental measures, three received local na-solabial flap and three received RFFF flap. All flap reconstruction (6/6) showed asymptomatic wound clo-sure and patient satisfaction at six months follow-up compared to patients managed with dental measures (1/4). All RFFF patients (3/3) showed increased bone deposition radiologically at six months compared to the dental group who showed a mixed (3/4) picture or worsened (1/4) picture. Nasolabial flap patients showed a mixed (2/3) or improved radiological picture (1/3). Conclusion: MRONJ is a relapsing disease. Preliminary evidence suggests that radical debridement with local nasolabial flap or RFFF reconstruction for advanced MRONJ is more effective at halting the disease and alleviating morbidity than conservative dental measures alone.

Closure of radial forearm free flap donor-site defect with proportional local full-thickness skin graft: case series study of a new design.

ObjectivesThe aim of this study was to describe a simple, convenient, and reliable new technique using local full-thickness skin graft (FTSG) for skin coverage of a donor-site defect of the radial forearm free flap (RFFF).Patients and Methods Between April 2016 and April 2021, five patients with oral squamous cell carcinoma underwent mass resection combined with RFFF reconstruction. After RFFF harvesting, donor-site defects were restored by proportional local FTSG.ResultsThe donor-site defects ranged in size from 24 to 41.25 cm2, with a mean of 33.05 cm2. Good or acceptable esthetic outcomes were obtained in all five patients. There was no dehiscence, skin necrosis, wound infection, or severe scarring at the graft site through the end of the postoperative follow-up period, and no patient had any specific functional complaint.ConclusionThe proportional local FTSG showed promising results for skin coverage of the donor-site defect of the RFFF. This technique could decrease the need for skin grafts from other sites.

Radial Forearm Free Flap Reconstruction of Glossectomy Defects Without Tracheostomy.

To assess the feasibility of radial forearm free flap (RFFF) reconstruction of glossectomy defects without tracheostomy tube (TT). Retrospective review of patients with at least oral tongue defects who underwent RFFF reconstruction. Pre- and intra-operative factors were documented. Post-operative respiratory complications included inability to extubate, pneumonia, or need for re-intubation or TT within 30 days. Twenty-one patients underwent RFFF reconstruction without TT, and 36 patients with TT. The average hospital length of stay was 1.5 days shorter in those without TT (P < .01). Two patients who underwent TT placement experienced a respiratory complication (P = .27). There were no respiratory complications among those without TT. After multivariate analyses, large tongue base defect (>25% resection, P < .001) and bilateral neck dissection (P < .001) were independently associated with TT placement. In our experience, RFFF reconstruction of glossectomy defects is feasible without TT among selected patients with small tongue base defects (≤25% resection) and unilateral neck dissection.

Negative-pressure wound therapy for donor-site closure in radial forearm free flap: A systematic review and meta-analysis.

Negative‐pressure wound therapy (NPWT) is often used for skin graft site dressing, and several studies have reported that its use improves skin graft failure in the forearm flap donor site. The present systematic review aimed to evaluate the efficacy of NPWT with skin graft for donor‐site closure in radial forearm free flap (RFFF) reconstruction. A systematic search in PubMed, Web of Science, and Cochrane Library databases was conducted. The search terms used for PubMed were ([radial forearm]) AND ([donor]) AND ([negative pressure or vacuum]). This review was registered in the International Prospective Register of Systematic Reviews and performed in accordance with the preferred reporting items for systematic reviews and meta‐analyses statement. Three prospective randomised controlled trials and three retrospective comparative studies were included. Compared with conventional bolster dressing, the use of NPWT dressing did not lead to significant improvements in partial skin graft loss, tendon exposure, and other complications. NPWT improved hand functionality earlier; nonetheless, the cost of the device and dressings was a disadvantage. The use of NPWT for skin graft fixation in the RFFF donor site is not generally recommended.

Magnitude of radial forearm free flaps and factors associated with loss of volume in oral cancer reconstructive surgery: Prospective study.

Adequate flap volume is key to maintaining oral function after oral cancer surgery. This study aimed to evaluate changes in radial forearm free flap (RFFF) volumes after 1 year of follow-up following ablative tumor surgery in the head and neck. A prospective study that recorded the clinical data of 20 patients with head and neck cancer who underwent RFFF reconstruction. Magnetic resonance (MR) and Mimics Research 19.0 software were used to measure the RFFF volumes at 1, 3, 6, and 12 postoperative months. Compared with one postoperative month, the RFFF volume decreased by 15.5%, 29.4%, and 42.0% at 3, 6, and 12 months, respectively, after surgery. A significant positive correlation between postoperative radiotherapy and RFFF volume changes was detected. The volume of RFFF decreases with time. It is recommended to use overcorrection, with a 40% increase in RFFF volume, to reconstruct head and neck tumor-related defects.

Free radial artery forearm flap reconstruction of forehead defect in a 2-year-old child

Reconstruction of soft tissue defect with exposed bone over the forehead is a technical challenge in pediatric population. The options vary from skin grafting, local flaps to complex microvascular tissue transfer. The local flaps leave unsightly scar in the neighboring area and may violate the hair bearing scalp, hair line and the direction of hair. Skin grafting requires a vascular bed for its take and the aesthetic appearance is inferior. The tissue expansion in an acute stage may not be an option. Here we present our experience of soft tissue reconstruction of a forehead defect in a 2-year-old child with free radial forearm flap (RAFF). To best of our knowledge free radial forearm flap has rarely been reported for usage in reconstruction of forehead defect in pediatric population.

Metastatic implantation of oral cancer in forearm: An unusual presentation

Metastatic implantation of cancer cells at a free flap graft donor site is a very unusual presentation. The possible mechanism is accidental contamination of the graft site by instruments used for surgery on the primary site. The other potential causes are the hematogenous spread of the tumor and de novo tumorigenesis. This report describes the case of a 65-year-old gentleman with carcinoma of the left buccal mucosa, which underwent wide local excision of the growth with type III modified radical neck dissection with radial forearm free flap reconstruction and subsequently developed a metastatic nodule over the graft donor site after 3 months. The nodule was excised with an adequate margin after which the patient refused to undergo any further treatment. Proper care taken while dealing with the tumor as well as the graft donor site shall avoid such iatrogenic complications due to possible accidental contamination of the graft donor area.

Predicting length of stay in head and neck patients who undergo free flap reconstruction.

ObjectiveUnderstanding factors that affect postoperative length of stay (LOS) may improve patient recovery, hasten postoperative discharge, and minimize institutional costs. This study sought to (a) describe LOS among head and neck patients undergoing free flap reconstruction and (b) identify factors that predict increased LOS.MethodsA retrospective cohort was performed of 282 head and neck patients with free flap reconstruction for oncologic resection between 2011 and 2013 at a tertiary academic medical center. Patient demographics, tumor characteristics, and surgical and infectious complications were characterized. Multivariable regression identified predictors of increased LOS.ResultsA total of 282 patients were included. Mean age was 64.7 years (SD = 12.2) and 40% were female. Most tumors were located in the oral cavity (53.9% of patients), and most patients underwent radial forearm free flap (RFFF) reconstruction (RFFF—73.8%, anterolateral thigh flap—11.3%, and fibula free flap—14.9%). Intraoperative complications were rare. The most common postoperative complications included nonwound infection (pneumonia [PNA] or urinary tract infection [UTI]) (15.6%) and wound breakdown/fistula (15.2%). Mean and median LOS were 13 days (SD = 7.7) and 10 days (interquartile range = 7), respectively. Statistically significant predictors of increased LOS included flap take back (Beta coefficient [C] = +4.26, P < .0001), in‐hospital PNA or UTI (C = +2.52, P = .037), wound breakdown or fistula (C = +5.0, P < .0001), surgical site infection (C = +3.54, P = .017), and prior radiation therapy (C = +2.59, P = .004).ConclusionSeveral perioperative factors are associated with increased LOS. These findings may help with perioperative planning, including the need for vigilant wound care, optimization of antibiotics prophylaxis, and institution‐level protocols for postoperative care and disposition of free flap patients.Level of Evidence2b; retrospective cohort.

Comparison of Clinical Results and Quality-of-Life in Tongue Cancer Patients Undergoing Submental Island Flap and Radial Forearm Free Flap Reconstruction

Our goal was to compare the clinical results and quality-of-life (QoL) in tongue cancer patients undergoing submental island pedicled (SIP) flap and radial forearm free (RFF) flap reconstruction. Patients undergoing SIP or RFF flap reconstruction for primary tongue squamous cell carcinoma were prospectively enrolled and were asked to complete the University of Washington Quality-of-Life (UW-QOL) questionnaire, version 4, at 12months after the operation. The study's main interest was QoL as well as locoregional recurrence control. A total of 190 patients were enrolled for analysis, and the SIP and RFF groups showed significant differences in patient age, American Society of Anesthesiologists classification, and hospital cost. In the survival analysis, locoregional recurrence occurred in 35 patients in the SIP group and 48 patients in the RFF group; the difference was not significant (P=.440). In the QoL analysis, compared with patients in the SIP group, those in the RFF group had higher scores in the domains of activity and recreation. No significant differences were found with respect to the other domains. The SIP flap and RFF flap have comparable survival control in tongue squamous cell carcinoma patients. The RFF flap might lead to better QoL, but the SIP flap imposes fewer limitations on patients' health status and is associated with lower hospital cost.