Functional Outcomes and Quality of Life Following Supraclavicular Flap Reconstruction in Oral Cancer Surgery: A Retrospective Analysis

Background and objective Oral cavity malignancies pose considerable challenges in surgical management, making optimal functional and aesthetic reconstruction crucial after tumor ablation. The supraclavicular flap (SCF) has gained popularity in head and neck reconstruction due to its reliable vascularity, adequate surface area, pliability, and low donor site morbidity. While evidence supporting its use in oral reconstruction is growing, systematic evaluation of functional outcomes and quality of life remains limited. This study aims to assess functional outcomes and quality of life following SCF reconstruction in patients with T2-T3 oral cavity malignancies over a 10-year period. Methodology This retrospective study was conducted at a rural tertiary care center, analyzing data from October 2014 to November 2024. A total of 40 patients with biopsy-confirmed squamous cell carcinoma involving the buccal complex and floor of the mouth who underwent SCF reconstruction were included. Data collected included demographics, tumor characteristics, surgical details, postoperative complications, and functional outcomes. Functional assessments focused on speech intelligibility, swallowing capacity, oral competence, and shoulder mobility at three, six, and 12 months postoperatively. Quality of life was evaluated using the World Health Organization Quality of Life-BREF questionnaire at six and 12 months. Statistical analysis was performed using paired t-tests for continuous variables and Cochran's Q test for categorical data, with significance set at p < 0.05. Results The study included 40 patients with a mean age of 54.7 years; the majority were female (67.5%). The buccal mucosa was the most common tumor site (80%), and 57.5% of patients presented with T2 lesions. The average operative time was 95 minutes, and the mean hospital stay was 8.4 days. Flap-related complications occurred in 35% of patients, with partial flap necrosis being the most common (17.5%). Speech intelligibility improved significantly from 64.5% at three months to 86.7% at 12 months (t = 7.92, p < 0.001). Swallowing function improved from a mean Functional Oral Intake Scale score of 4.1 to 6.1 over the same period (t = 9.45, p < 0.001). By 12 months, 82.5% of patients achieved full oral intake without restrictions. Shoulder abduction improved from 121.7° to 157.9° (t = 10.32, p < 0.001). Quality-of-life scores significantly improved between six and 12 months in physical health (59.6 to 68.5, t = 5.78, p < 0.001), psychological well-being (61.3 to 67.9, t = 2.46, p = 0.018), and overall quality of life (61.8 to 68.3, t = 2.89, p = 0.006). At 12 months post-surgery, 62.5% of patients demonstrated excellent functional outcomes, and 15% had good outcomes. Conclusions The SCF is an axial fasciocutaneous flap that offers reliable reach to oral cavity defects with minimal donor site morbidity. It is a practical and effective reconstructive option for T2-T3 oral cancers, offering comparable quality-of-life outcomes to microvascular free flaps. The SCF is easy to harvest, pliable, and has dependable vascularity. It also reduces operative time and financial burden, making it particularly beneficial for patients at risk due to long anesthesia duration, peripheral vascular disease, or major comorbidities.