Operative Efficiency and Early Outcomes of Sternocleidomastoid Muscle Flap Versus Microvascular Free Flap for Floor-of-Mouth Reconstruction.

BACKGROUND

Microvascular free flaps are standard for complex floor-of-mouth (FOM) reconstruction, but regional options may be preferable for selected soft-tissue defects not requiring bony reconstruction.

PURPOSE: To compare operative time and early outcomes between sternocleidomastoid (SCM) muscle flaps and microvascular free flaps after oncologic FOM resection.

STUDY DESIGN, SETTING, SAMPLE: This retrospective cohort study was conducted at Bakırçay University Çiğli Training and Research Hospital. The sample included adult subjects who underwent oncologic FOM resection with immediate soft-tissue reconstruction between January 2022 and May 2026. Subjects were excluded if reconstruction was performed with other regional flaps, required bony reconstruction, or had missing outcome data.

PREDICTOR VARIABLE: Primary FOM reconstruction technique, grouped as SCM muscle flap or microvascular free flap.

MAIN OUTCOME VARIABLES: Primary outcome was operative time. Secondary outcomes were length of stay (LOS), postoperative day of first oral intake, oral intake before discharge, and postoperative complications.

COVARIATES: Age, sex, American Society of Anesthesiologists class, defect extent, and tumor stage.

ANALYSES: Bivariate analyses used Mann-Whitney U, χ2, or Fisher's exact tests. Multivariable linear regression was performed for continuous outcomes.

RESULTS

The sample included 33 subjects: 17 SCM flaps and 16 free flaps. Operative time was 295.3 (99.9) and 456.8 (156.4) minutes for the SCM and free flap groups, respectively (P = .003). LOS was 13.2 (4.5) and 20.4 (6.1) days, respectively (P = .002). Intensive care unit (ICU) LOS was 0.4 (0.5) and 1.6 (0.6) days, respectively (P < .001). ICU admission occurred in 7 of 17 SCM subjects (41.2%) and 16 of 16 free flap subjects (100%) (P < .001). Postoperative day of first oral intake was 11.0 (6.6) and 12.3 (3.5) days, respectively (P = .1). In adjusted models, free flap reconstruction was associated with longer operative time (b = 204.2 minutes; P = .005), LOS (b = 6.7 days; P = .027), and ICU stay (b = 1.4 days; P < .001).

CONCLUSIONS AND RELEVANCE: For selected FOM soft-tissue defects not requiring bony reconstruction, SCM muscle flap reconstruction was associated with shorter operative time, shorter hospitalization, and reduced ICU use with comparable early oral intake.