Objective: The aims of study to evaluate the functional and aesthetic outcomes of various local and regional flaps used for immediate reconstruction of oro-mandibular defects following tumor resection in Hadhramout National Oncology Center.

Methods: This prospective study of 156 patients with Stage I–III oral, mandibular, or oro-mandibular tumors, predominantly squamous cell carcinoma (91.7%), underwent immediate reconstruction at Hadhramout National Oncology Center from January 2013 to March 2025. Flaps included local tongue and buccal flaps, pectoralis major myocutaneous (PMMC), submental, nasolabial, temporal, deltopectoral, forehead, and bilateral Karapandzic flaps. Functional and cosmetic outcomes were assessed preoperatively and six months postoperatively using the University of Washington Questionnaire. Statistical analysis (Chi-square test, Cramer’s V) was performed to evaluate associations between flap type and postoperative outcomes.

Results: Among 156 patients (96 males, 60 females; mean age: 52 years), squamous cell carcinoma predominated (91.7%). Soft tissue defects were most common (62.2%), and local flaps were the most frequently used (34.6%). The overall flap success rate was 98.1%. Functional outcomes were significantly associated with flap type (χ2(7)=105.026, p<0.001; Cramer’s V=0.82). Submental, PMMC, and local flaps yielded the highest rates of excellent functional outcomes. Aesthetic outcome was also significantly associated with flap type (χ2(9)=18.863, p=0.026; Cramer’s V=0.35), with nasolabial and local flaps performing best. Complications, including partial flap loss (1.3%) and orocutaneous fistula (1.3%), were minimal. Statistical analysis revealed significant associations between flap type and outcomes, with local and submental flaps excelling in both function (p < 0.001) and aesthetics (p = 0.026).

Conclusion: This study underscores the viability of pedicled flaps particularly PMMC and submental flaps in settings lacking microsurgical infrastructure, offering reliable functional and cosmetic reconstruction of oro-mandibular defects while maintaining acceptable morbidity and quality-of-life outcomes. These techniques provide viable alternatives to free flap reconstruction and support extensive oncologic resection without compromising postoperative quality of life.