Objective: To compare the application of the radial forearm flap, anterolateral thigh flap and lateral arm flap when reconstructing oral-maxillofacial defects.

Methods: 154 consecutive cases of various defects reconstruction with the three kinds of soft tissue free flaps were reviewed. There were 99 cases with forearm flap, 34 cases with anterolateral thigh flap and 21 cases with later arm flap. All the clinic data including the primary diseases, the site of defects, the average operation time of flap harvest, the survival rate of flap transfer and the perioperative complications were analyzed.

Results: All the forearm flap, anterolateral thigh flap and lateral arm flap could reconstruct the defects of maxilla, palate, tongue, cheek, retromolar and oralpharyngeal. Anterolateral thigh flap were more often used for maxillary reconstruction (16/34). The average operation time of the flap harvest was 41.5 min, 46.4 min and 42.4 min, respectively, and the survival rate was 96.0%, 94.1% and 90.5%, respectively. There was no significant difference among the three groups. Skin graft is necessary for the donor site in all the cases with forearm flap. The donor site could be closed directly without skin graft in all the cases with anterolateral thigh flap and lateral arm flap. Radial nerve injury was reported in one case with forearm flap and 2 cases with lateral arm flap.

Conclusions: The anterolateral thigh flap and lateral arm flap are safe and reliable alterative to the forearm flap for oral-maxillofacial defects reconstruction with the advantages of non-visible donor site scar and no need of skin graft.

Conflict of interest: None declared.