Comparative Analysis of Super‐Thin Anterolateral Thigh and Radial Forearm Free Flap Reconstruction for Oral Cavity Defects

ABSTRACT Background The radial forearm free flap (RFFF) has been a mainstay in head and neck reconstruction due to its reliability and pliability, but it carries notable donor‐site morbidity. The super‐thin anterolateral thigh free flap (ST‐ALTFF) has recently emerged as a versatile alternative. Methods A retrospective chart review was performed including patients who underwent free flap reconstruction with either ST‐ALTFF or RFFF following oral cavity squamous cell carcinoma resection. Demographic and peri‐operative variables were collected, and statistical analysis was performed using the t ‐test, Mann–Whitney U test, and Fisher exact probability test. Results Twenty‐one patients underwent ST‐ALTFF and twenty‐two underwent RFFF reconstruction. Patients receiving RFFF were more likely to be female ( n = 16, p < 0.001) and have higher mean BMI ( p = 0.048). Operative time was shorter with ST‐ALTFF versus RFFF (509 vs. 594 min, p < 0.011). Other patient variables, complications, gastrostomy tube placement, and post‐operative pain were similar. Conclusion ST‐ALTFF represents a viable reconstructive option with promising peri‐operative outcomes compared to RFFF. Level of Evidence 4