Lean Management in Medium-Sized Oral Cavity Defect Reconstruction: Facial Artery Musculomucosal Flaps Versus Free Flaps

Background/Objectives: Oral cavity defects highlight the necessity for individualized reconstructive strategies given their anatomical and functional complexity. Reconstructive surgery should optimize healing and function, minimize complications, and reduce operative time and costs. Although free flaps remain the gold standard for oral cavity reconstruction, they require large teams, specialized microsurgical equipment, and extended operative times. Methods: A retrospective analysis was performed on 59 consecutive patients who underwent intraoral reconstruction for medium-sized oral cavity defects between 2022 and 2025, using either a facial artery musculomucosal (FAMM) flap or a free flap. Statistical comparisons were made for excision parameters, operative variables, length of hospitalization, and postoperative outcomes. Results: Comparison between the FAMM and free flap reconstruction groups revealed no significant differences in patient age, gender, histopathological diagnosis, lesion size, oncological radicality, or functional outcomes related to speech and alimentation. However, FAMM flap reconstruction was associated with significantly reduced operative time (196.7 ± 94.9 min vs. 427.1 ± 129.8 min; p < 0.001), representing a 54% reduction in procedure duration. Similarly, the mean hospital stay was 40% shorter in the FAMM group (12.7 ± 6.0 days vs. 21.1 ± 8.0 days; p < 0.001). Intensive care unit admission was also markedly less frequent following FAMM flap reconstruction (7.3% vs. 83.3%; p < 0.001). Conclusions: In cases of small and medium-sized oral cavity defects, reconstruction using FAMM flaps represents a favorable alternative to free flap reconstruction, offering comparable functional outcomes while significantly reducing operative time and length of hospitalization.