Feasibility and role of the lateral arm free flap following pull-through oropharyngectomy for tonsillar carcinoma: a clinical analysis

The mandible-preserving pull-through oropharyngectomy (MPPO) offers a less morbid alternative for traditional mandibular swing approach, particularly for tonsillar carcinoma. The lateral arm free flap (LAFF) is a versatile and reliable option for soft tissue reconstruction, particularly suitable for small-to-medium-sized defects of the oropharyngeal region. This study is a retrospective study including data from 23 patients with tonsil carcinoma, diagnosed and treated at a tertiary referral center. The QLQ-C30, QLQ-H&N35 inventories, were administered at three different timepoints: At 1-month, 3-month and 6-month postoperatively. The flap-related data and the quality-of-life data were collected and presented in a descriptive manner. Most flaps survived (95.65%), one case of necrosis occurred, while 8.70% patients experienced recipient-site bleeding, 4.35% and 21.74% of patients experienced systemic complications such as pulmonary embolism and hypoalbuminemia respectively. Following surgery, all patients successfully underwent decannulation (average 28.22 days) and NGT extraction (average 12.09 days). Among ten patients with complete QoL data, global QoL and most functional domains improved over six months, with resolution of fatigue, insomnia, speech, social, and cough issues but a worsening of xerostomia. The LAFF reconstruction in tonsil carcinoma patients with MPPO surgery demonstrates favorable postoperative outcomes and QoL results in our institution. This study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board of West China Hospital, Sichuan University (Approval No. 2025‑1235; Date: 1 February 2025). Written informed consent was obtained from all participants. As a retrospective analysis of a standard reconstructive technique, this study did not require prospective trial registration.