Conventional vs. tunnelized facial artery myomucosal flaps in oral cavity reconstruction: a comparative analysis of outcomes and quality of life

The facial artery myomucosal (FAMM) flap (conventional FAMM flap) and the tunnelized FAMM island flap (tunnelized FAMM flap) are established techniques for oral cavity reconstruction. However, evidence on complications rates is limited to small cohorts, and long-term quality of life (QoL) data are lacking. This study aimed to (1) determine the prevalence of complications, (2) identify risk factors for complications, and (3) compare QoL outcomes between patients with conventional and tunnelized flaps. This single-center, retrospective study included all patients, who underwent oral cavity cancer ablation with reconstruction using either a unilateral conventional or tunnelized FAMM flap between 2018 and 2025. Demographics, surgical details, complications, and EORTC QLQ-H&N35 scores at 12-, 24-, and 36-months were analyzed. Uni- and multivariate analyses were performed. In total, 141 patients were included, reconstructed with either conventional (n = 114, 81%) or tunnelized (n = 27, 19%) FAMM flaps. Complications occurred in 18 patients (13%), including partial (n = 7) or total (n = 5) flap necrosis, hematoma (n = 5), and infection (n = 1). Tunnelized FAMM flaps were associated with significantly higher complication rates (37%) compared with those receiving a conventional FAMM flap (7%; p < 0.001). Flap type was the only statistically significant risk factor for complications in multivariate analyses. Long-term QoL outcomes were similar between groups. Based on our cohort and surgical techniques (without including the facial vein in the tunnelized FAMM flap), the conventional FAMM flap was a safe and reliable flap, while the tunnelized FAMM flap was associated with increased risk of complications and without QoL benefits.