Donor‐Site Outcomes of the Superficial Circumflex Iliac Artery Perforator Flap Versus Radial Forearm Flap in Unilateral Tongue Reconstruction: A Propensity Score Matching Analysis

ABSTRACT Background We compared the superficial circumflex iliac artery perforator (SCIP) flap with the radial forearm flap (RFF) to identify limitations restricting its widespread use. Methods We retrospectively evaluated unilateral tongue reconstruction using propensity score matching for age, sex, T stage, body mass index, and Charlson comorbidity index from a nonfunctional perspective. Results Matching 118 patients yielded 27 pairs. Flap survival was comparable. SCIP improved donor‐site aesthetics (92.6% vs. 40.7%), preserved strength (100.0% vs. 66.7%), and shortened hospitalization (10.9 vs. 11.9 days). Overall recipient‐site and flap‐related complications were significantly higher (33.3% vs. 3.7%), driven by Grades I–II events (25.9% vs. 0%). No individual complication category differed significantly. SCIP had a shorter pedicle, more tracheotomies, and greater superior thyroid artery use. Before matching, salvage failed in 5/5 SCIP versus 2/5 RFF cases, an exploratory finding. Conclusions SCIP improves donor‐site outcomes, but more low‐grade complications and vessel considerations may limit widespread adoption.