Comparative Effectiveness Between Radial Forearm Flap and Pectoralis Major Myocutaneous Flap for Tongue Carcinoma Reconstruction: A Systematic Review and Meta-analysis

Reconstruction following tongue carcinoma resection is critical for restoring speech, swallowing, and overall quality of life. Among the available reconstructive options, the radial forearm free flap (RFF) and pectoralis major myocutaneous flap (PMMF) are commonly used techniques. However, uncertainty remains regarding their comparative effectiveness, particularly in hemi- and total glossectomy defects.

To systematically evaluate and compare the effectiveness of RFF and PMMF in tongue cancer reconstruction with respect to functional outcomes, complications, and quality of life (QOL).

This systematic review was conducted according to PRISMA 2020 guidelines and registered in PROSPERO. Electronic databases were searched till April 2025. Comparative studies evaluating RFF and PMMF in tongue carcinoma patients (T1–T4) were included. Risk of bias was assessed using the Newcastle–Ottawa Scale. Meta-analysis was performed using a random-effects model, with standardized mean difference (SMD) as the summary measure.

Six retrospective studies comprising 380 patients were included for qualitative synthesis, and four studies were eligible for meta-analysis. Pooled analysis demonstrated a trend toward improved speech (SMD = 0.35) and swallowing outcomes (SMD = 0.18) in the RFF group, although statistical significance was not achieved. Combined speech and swallowing outcomes in hemi-glossectomy patients demonstrated a statistically significant trend favouring RFF (SMD = 1.63, p < 0.05); however, substantial heterogeneity among studies limits the reliability and generalizability of this finding. Complication rates, including dehiscence and fistula formation, were generally lower with RFF. Quality-of-life parameters also demonstrated favourable trends in the RFF group. Also, as fewer studies were included, funnel plot assessment is underpowered, and publication bias could not be reliably determined.

RFF showed a trend toward improved functional outcomes and lower complication rates compared with PMMF, particularly in hemi-glossectomy defects; however, several pooled outcomes did not achieve statistical significance. Flap selection should consider tumor extent, patient comorbidities, and anticipated adjuvant therapy. High-quality prospective studies are required to strengthen the current evidence base.