Comparison of short-term postoperative complications between free flap and locoregional flap reconstruction in stage III-IV oral cavity cancer

Abstract

Background: Optimal reconstruction for advanced oral cavity cancer requires balancing functional restoration against surgical morbidity. Free tissue transfer is the standard, yet locoregional flaps remain crucial in resource-limited settings. Their comparative short-term complication rates remain contested.

Objective: To compare short-term postoperative complications between free flap and locoregional flap reconstruction in stage III-IV oral cavity cancer.

Methods: A retrospective cohort study included 92 patients with stage III-IV oral squamous cell carcinoma who underwent immediate reconstruction at Buriram Hospital between August 2012 and August 2025 . Patients were grouped into free flap (n = 40) and locoregionalflap (n = 52) groups. The primary outcome was the 30-day overall complication rate. Multivariable logistic regression identified independent predictors of postoperative complications.

Results: Overall complication rates were similar between free flap and locoregional flap groups (47.5% vs. 44.2%; P = 0.755). Operative time was longer for free flaps (P < 0.001), but hospital stay and mortality were comparable. Positive surgical margins were more common with locoregional flaps (46.2% vs. 15.0%; P = 0.002). Advanced disease stage was associated with increased complication risk; T4 stage was an independent predictor of postoperative complications, while nodepositive disease showed a similar trend.

Conclusion: Free flap and locoregional flap reconstruction demonstrate dcomparable short-term complication rates in advanced oral cavity cancer. Complication risk appeared to be more strongly associated with advanced tumor burden than reconstruction technique. Flap selection should be individualized based on defect characteristics, patient factors, and available resources.