Reconstruction of Oromandibular Defects With Radial Forearm Free Flaps and Fibular Free Flaps: One-Year Experience From Hospital Selayang and the National Cancer Institute, Malaysia

Background Oromandibular defects are complex to reconstruct, often requiring free tissue transfer. Radial forearm free flaps (RFFFs) and vascularized fibular free flaps (VFFFs) are among the most established techniques. This study aimed to evaluate short-term outcomes, complications, and donor-site morbidity of RFFFs and VFFFs in oromandibular reconstruction over a one-year period at Hospital Selayang and the National Cancer Institute, Malaysia. Methodology A retrospective review was conducted of patients who underwent oromandibular reconstruction with RFFFs or VFFFs between July 2022 and July 2023. Outcomes assessed included flap survival, donor-site morbidity, and patient satisfaction. Results A total of 16 patients were included, of whom 10 received an RFFF and six received a VFFF. All RFFF cases achieved 100% early flap survival, while one VFFF case (13%) failed and required removal. Donor-site morbidity in the RFFF group included superficial radial nerve sensory deficits (70%), cold intolerance (40%), and dissatisfaction with scarring (40%). In the VFFF group, no foot drop, nerve injury, or ankle instability occurred; however, leg swelling (40%) and cold intolerance (40%) were reported. Conclusions Both RFFF and VFFF are effective for oromandibular reconstruction. RFFF is more suitable for soft tissue defects, while VFFF remains the preferred option for osseous reconstruction. To maximize outcomes, it is necessary to individually select flaps based on defect characteristics and patient factors.