Donor-Site Outcomes of the Superficial Circumflex Iliac Artery Perforator Flap Versus Radial Forearm Flap in Unilateral Tongue Reconstruction: A Propensity Score Matching Analysis.

BACKGROUND: We compared the superficial circumflex iliac artery perforator (SCIP) flap with the radial forearm flap (RFF) to identify limitations restricting its widespread use. METHODS: We retrospectively evaluated unilateral tongue reconstruction using propensity score matching for age, sex, T stage, body mass index, and Charlson comorbidity index from a nonfunctional perspective. RESULTS: Matching 118 patients yielded 27 pairs. Flap survival was comparable. SCIP improved donor-site aesthetics (92.6% vs. 40.7%), preserved strength (100.0% vs. 66.7%), and shortened hospitalization (10.9 vs. 11.9 days). Overall recipient-site and flap-related complications were significantly higher (33.3% vs. 3.7%), driven by Grades I-II events (25.9% vs. 0%). No individual complication category differed significantly. SCIP had a shorter pedicle, more tracheotomies, and greater superior thyroid artery use. Before matching, salvage failed in 5/5 SCIP versus 2/5 RFF cases, an exploratory finding. CONCLUSIONS: SCIP improves donor-site outcomes, but more low-grade complications and vessel considerations may limit widespread adoption.