Islanded facial artery myomucosal flap versus free anterolateral thigh flap in oral reconstruction: a cost-effectiveness analysis

Background: The free anterolateral thigh (ALT) flap has long been the standard for reconstructing oral defects following the resection of squamous cell carcinoma (SCC) in the oral tongue (OT) or floor of the mouth (FOM). However, recent case-series studies suggest that the islanded facial artery myomucosal (FAMM) flap also yields satisfactory results for moderate-sized oral defects. Although the islanded FAMM flap avoids the need for vascular micro-anastomosis, its advantages over the ALT flap remain unconfirmed. This study aims to compare the cost-effectiveness of the islanded FAMM flap with the free ALT flap in the reconstruction of moderate-sized oral defects following early-stage OT/FOM SCC resection. Methods: A single-centered retrospective cohort study was conducted on patients undergoing compartmental resection of OT/FOM SCC with subsequent reconstruction using either islanded FAMM flap or free ALT flap. Data on patient characteristics, operating duration, tracheostomy rate, ICU days, post-operative days, complications, mouth opening, swallowing, speech, aesthetics, and hospitalization costs were compared. Results: Thirty-one patients with OT/FOM SCC were included; 16 underwent reconstruction with the islanded FAMM flap, while 15 received the free ALT flap. The FAMM flap group exhibited shorter operating times (514 ± 66.2 vs. 602.6 ± 95.2 min), significantly lower tracheostomy rates (12.5% vs. 100%), higher esthetic scores (6.8 ± 1.5 vs. 4.9 ± 1.3), and reduced hospitalization costs (59,286 ± 13,903 yuan vs. 95,224 ± 18,223 yuan). Functional outcomes related to mouth opening, swallowing, and speech were comparable between the two groups. Conclusions: The islanded FAMM flap emerges as a cost-effective alternative to the free ALT flap for moderate-sized tongue defects, delivering similar functional outcomes while offering superior esthetic results and lower overall costs; however, its advantages still needs to be further investigated in prospective randomized control study.