Donor site outcomes and functional recovery are improved with superficial inferior epigastric artery perforator flap compared to radial forearm flap in oral and maxillofacial reconstruction.

Abstract

Objective: To compare the efficacy of the superficial inferior epigastric artery perforator (SIEA) flap and radial forearm (FA) flap in reconstructing oral and maxillofacial soft tissue defects, with emphasis on donor site complications, functional recovery, aesthetic outcomes, and quality of life.

Methods: A retrospective analysis was conducted on 204 patients who underwent SIEA (n = 104) or FA (n = 100) flap reconstruction between 2014 and 2023. Outcomes assessed included flap survival, donor site complications (scarring, sensory abnormalities), functional recovery (mouth opening, speech clarity), and quality of life (based on UW-QOL). Statistical analysis included chi-square tests, t-tests, and logistic regression.

Results: Flap survival rates were similar between groups (P = 0.411). However, the SIEA group exhibited significantly better donor site outcomes: fewer sensory abnormalities (P < 0.001), less severe scarring (P < 0.001), and greater aesthetic satisfaction (P = 0.027). Functional outcomes also favored the SIEA flap, with improved mouth opening (P = 0.024) and speech clarity (P < 0.001). However, SIEA reconstruction required longer operative time (P < 0.001). Independent risk factors for delayed donor site healing included age ≥ 60 years, BMI ≥ 23 kg/m², smoking, diabetes, and extended hospitalization.

Conclusion: The SIEA flap offers superior donor site aesthetics, sensory preservation, and functional recovery compared to the FA flap, though it is associated with longer operative time. The FA flap remains a reliable option. Preoperative planning should consider individualized flap selection based on vascular anatomy, comorbidities, and aesthetic goals.