Louizakis Alexandros, Antoniou Asterios, Kalaitsidou Ioanna, Tatsis Dimitris
Department of Oral and Maxillofacial Surgery, Aristotle University of Thessaloniki, Specialized Cancer Treatment and Reconstruction Centre, General Hospital of Thessaloniki "George Papanikolaou", Thessaloniki, GRC.
Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, CHE.
Cureus. 2025 May 23;17(5):e84711. doi: 10.7759/cureus.84711. eCollection 2025 May.
Reconstructive surgery for oral cavity defects has progressed from early pedicled locoregional flaps, like the pectoralis major myocutaneous flap, to sophisticated microvascular free flaps, driven by the need to restore critical functions such as speech, swallowing, and chewing, alongside aesthetic outcomes essential for patient quality of life. This narrative review compares the effectiveness, outcomes, and current roles of microvascular free flaps versus locoregional flaps in reconstructing small to moderate oral cavity defects. A narrative literature review was conducted, analyzing retrospective studies, meta-analyses, and clinical series, focusing on flap success rates, functional and aesthetic outcomes, complications, and resource utilization for key flaps, including radial forearm free flap (RFFF), anterolateral thigh flap (ALT), submental island flap (SMIF), supraclavicular artery island flap (SCAIF), and facial artery musculomucosal (FAMM) flap. Microvascular free flaps achieve high success rates and excel in complex three-dimensional reconstructions, offering superior functional outcomes, but demand prolonged operative times, specialized expertise, and significant resources, limiting their feasibility in low-resource settings. Locoregional flaps provide comparable success for smaller defects, with shorter operative times, lower costs, and suitability for high-risk patients. Both approaches yield favorable aesthetic results when appropriately selected, with locoregional flaps offering better tissue matching in facial reconstructions. Free flaps remain the gold standard for complex defects, while locoregional flaps are effective, cost-efficient alternatives for smaller defects, particularly in comorbid patients or resource-constrained environments. Clinical decisions should consider defect complexity, patient health, and institutional capabilities, with future advancements in tissue engineering and surgical training poised to enhance outcomes and accessibility. The aim of this review is to clarify the differences between the traditionally used locoregional flaps and the more recent microvascular free flaps.
口腔缺损的重建手术已从早期的带蒂局部皮瓣，如胸大肌肌皮瓣，发展到复杂的微血管游离皮瓣，这是由恢复言语、吞咽和咀嚼等关键功能的需求推动的，同时也是患者生活质量所必需的美学效果的要求。这篇叙述性综述比较了微血管游离皮瓣与局部皮瓣在重建中小型口腔缺损方面的有效性、结果和当前作用。进行了一项叙述性文献综述，分析回顾性研究、荟萃分析和临床系列，重点关注皮瓣成功率、功能和美学结果、并发症以及关键皮瓣的资源利用情况，包括桡侧前臂游离皮瓣（RFFF）、股前外侧皮瓣（ALT）、颏下岛状皮瓣（SMIF）、锁骨上动脉岛状皮瓣（SCAIF）和面动脉肌黏膜瓣（FAMM）。微血管游离皮瓣成功率高，在复杂的三维重建中表现出色，功能结果优越，但手术时间长，需要专业技能和大量资源，限制了其在资源匮乏地区的可行性。局部皮瓣在较小缺损的重建中成功率相当，手术时间短、成本低，适合高危患者。当选择适当时，两种方法都能产生良好的美学效果，局部皮瓣在面部重建中组织匹配性更好。游离皮瓣仍然是复杂缺损的金标准，而局部皮瓣是较小缺损的有效、经济高效的替代方法，特别是在合并症患者或资源有限的环境中。临床决策应考虑缺损的复杂性、患者健康状况和机构能力，组织工程和手术培训的未来进展有望提高治疗效果和可及性。本综述的目的是阐明传统使用的局部皮瓣和最新的微血管游离皮瓣之间的差异。
