Submental Island Flap vs Radial Forearm Free Flap in Tongue Reconstruction

Surgical reconstruction following tongue cancer resection is essential for restoring oral function, speech, swallowing, and facial aesthetics. The Radial Forearm Free Flap (RFFF) is widely considered a gold standard for soft tissue oral reconstruction; however, it requires microvascular expertise and carries donor-site morbidity. The Submental Island Pedicled Flap (SIPF) serves as an alternative, offering a reliable regional pedicled flap with local color match and simplified surgical execution without requiring microvascular anastomoses.

This retrospective observational cohort study aims to compare patients who received SIPF versus RFFF for tongue reconstruction. The primary objective is to evaluate health-related quality of life outcomes using the validated University of Washington Quality of Life Questionnaire version 4 (UW-QOL v4), alongside evaluating postoperative surgical outcomes and donor site morbidity.

Inclusion criteria

• Adult patients (aged 18 years or older) diagnosed with squamous cell carcinoma of the tongue requiring partial or total glossectomy.
• Indication for immediate soft tissue reconstruction using either Submental Island Pedicled Flap (SIPF) or Radial Forearm Free Flap (RFFF).
• Patients eligible and cleared for major surgical resection and flap reconstruction under general anesthesia.
• Patient's informed consent to participate in the study and complete follow-up evaluations.

Exclusion criteria

• History of previous radiation therapy or surgical intervention in the head and neck region.
• Clinical or radiological evidence of nodal metastasis in level I submental lymph nodes (for SIPF candidates).
• Severe systemic comorbidities precluding major surgery or prolonged general anesthesia (ASA class IV or higher).
• Distance or inability to commit to the 12-month postoperative follow-up schedule and quality of life assessments.