Comparison of the efficacy and quality of repair of soft tissue defects after oral squamous cell carcinoma with anterolateral thigh flap and forearm flap: a meta-analysis

doi:10.19438/j.cjoms.2026.06.011

Abstract

Abstract: PURPOSE: To systematically evaluate the effectiveness and quality of anterolateral thigh flaps(ALTF) and forearm flaps (FF) for repairing soft tissue defects after oral squamous cell carcinoma surgery. METHODS: The literatures on the repair of soft tissue defects in patients with oral squamous cell carcinoma after surgery by ALTF and FF were systematically retrieved from databases such as PubMed, Embase, Medline, Cochrane Library, CNKI, Wanfang, and VIP. The retrieval time was from the establishment of the databases to October 1, 2024. The researchers conducted literature collection, quality evaluation, data extraction strictly in accordance with the inclusion and exclusion criteria, and cross-checked. Then, meta-analysis was performed using RevMan 5.4 software. RESULTS: A total of 36 studies were finally included,involving 2 570 patients. The results of meta-analysis showed that in terms of flap preparation time, the time for FF was significantly less than that for ALTF [MD=3.73, 95%CI(0.20, 7.26), P=0.04], but there was no significant difference in the total duration of operation [MD=17.20, 95%CI(-9.33, 43.73), P=0.20]. In terms of postoperative complications in the surgical area, ALTF had a lower incidence of postoperative pigmentation, hypertrophic scarring, and abnormal sensation in the surgical area [OR=0.07, 95%CI(0.03, 0.16), P<0.00001; OR=0.18, 95%CI(0.11, 0.29), P<0.00001; OR=0.24, 95%CI(0.10, 0.59), P=0.002]. In terms of postoperative oral function, ALTF had a lower incidence of temporal/permanent functional impairment [OR=0.10, 95%CI (0.06, 0.15), P<0.00001; OR=0.12, 95%CI(0.05, 0.25), P<0.00001], and ALTF also significantly outperformed FF in terms of postoperative chewing function scores [MD=0.72, 95%CI (0.62, 0.82), P<0.00001]. CONCLUSIONS: FF can reduce the technical difficulty of flap harvesting and shorten operative time, making it more suitable for surgeons or institutions newly adopting free flap techniques. In contrast, ALTF demonstrates a lower incidence of postoperative complications and provides superior oral functional recovery compared to FF. Therefore, if the goal is to minimize postoperative complication risks or achieve better oral functional rehabilitation, ALTF is the preferred choice.

Key words: Anterolateral thigh flap, Forearm flap, Oral squamous cell carcinoma, Complications, Oral function, Meta analysis

CLC Number:

Zhan Fang, Wang Kexin, He Zongxuan, Wang Lin, Song Kai, Shang Wei. Comparison of the efficacy and quality of repair of soft tissue defects after oral squamous cell carcinoma with anterolateral thigh flap and forearm flap: a meta-analysis[J]. China Journal of Oral and Maxillofacial Surgery, 2026, 24(1): 65-77.

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