The submental island (SMI) flap is a pedicled flap graft suitable for the reconstruction of small and medium sized defects in the oral cavity. Currently, it is unclear whether the submandibular preparation of the vascular pedicle is associated with a reduced prognosis of patients with oral cancer. 45 patients who had been treated for in sano-resection of oral cancer with an SMI flap were compared to 45 patients who were treated with a free radial forearm flap. The two groups were matched according to T stage, N stage, age and gender. The minimum postoperative follow-up was 12 months, the average observation period was 26.8 months. These two groups were compared regarding time of surgery, hospitalization, complication and recurrence rates (Wilcoxon test). The mean operative time was for patients with SMI Flap significantly shorter, as was duration of intensive care and hospitalization ( p < 0.01). In the group of patients with SMI flap 4 patients suffered from a relapse during the observation period, the patients with radial forearm flap 5 patients suffered from a relapse (no significance). The submandibular preparation of the vascular pedicle of the submental island flap is not related to a reduction of the individual prognosis of the patients, however, other parameters such as duration of surgery, hospitalization and complication rates were superior for the SMI flap when compared to the free radial forearm flap.