Comparative assessment of early surgical recovery and functional outcomes following anterolateral thigh and radial forearm free flap reconstruction for oral soft-tissue defects in a tertiary care centre

Background: Reconstruction of oral cavity soft-tissue defects following oncological resection is essential for restoration of oral function and minimization of donor-site morbidity. Anterolateral thigh free flap (ALTFF) and radial forearm free flap (RFFF) are commonly used reconstructive options. This study compared their early surgical and functional outcomes. Methods: A prospective observational study was conducted in the Department of Plastic Surgery, King George Hospital, Visakhapatnam, from May 2025 to April 2026. Fifty patients requiring free-flap reconstruction of oral cavity defects were included. Twenty-eight patients underwent ALTFF reconstruction and 22 underwent RFFF reconstruction. Flap survival, defect and flap dimensions, donor-site complications, and postoperative mouth opening were assessed. Results: The mean age was 54.64±8.89 years, and 60% of patients were female. ALTFF was used in 56% and RFFF in 44% of cases. Mean defect and flap surface areas were significantly greater with ALTFF than RFFF (61.53±19.51 vs 42.22±10.77 cm², p=0.0001; 138.62±42.26 vs. 74.46±15.89 cm², p<0.0001). Flap survival was 89.3% with ALTFF and 86.4% with RFFF. RFFF donor-site graft loss occurred in 40.9% of cases. Mean mouth opening improved from 4.15±1.15 cm preoperatively to 4.71±0.58 cm postoperatively. Conclusions: Both ALTFF and RFFF provided satisfactory early surgical and functional outcomes. ALTFF facilitated reconstruction of larger defects with lower donor-site morbidity, while RFFF provided reliable reconstruction with acceptable functional outcomes. Flap selection should be individualized according to defect characteristics and tissue requirements.