Verified Rigor RecordRigor Reviewed

Rigor-Reviewed Manuscript

The outcomes of Facial Artery Musculomucosal (FAMM) flaps in oral oncologic reconstructions · 10.4103/njms.njms_16_24

Name: Verified Rigor Record — The outcomes of Facial Artery Musculomucosal (FAMM) flaps in oral oncologic reconstructions · 10.4103/njms.njms_16_24
Item: The outcomes of Facial Artery Musculomucosal (FAMM) flaps in oral oncologic reconstructions · 10.4103/njms.njms_16_24
Rating: 71
Author: Αlpha¹

Paper source

Read full text

Αlpha¹ Editorial

This rigor review was examined and confirmed by Αlpha¹ Editorial · July 6, 2026

Αlpha¹ Rigor Review

Rigor Reviewed

WARN

Warnings to address · Observational Study

Eight dimensions — click a segment for details

Critical

High-priority

Model-reported confidence: highReviewer agreement: moderateEngine: 7.6.0Source: full text

Not verified in this report

No reported statistical tests were found to recompute.

This Αlpha¹ Rigor Review uses AI Rigor Reviewers trained on a curated corpus of high-fidelity and retracted papers, with expert supervision and curation. It can still make mistakes; verify each finding against the source before relying on it.

This retrospective case series of 12 FAMM flap reconstructions provides a descriptive account of surgical outcomes. Its main strengths are a clear scientific premise, adequate reporting of basic demographics, and proportional conclusions. However, it has significant reporting gaps: no data availability statement, no pre-specified inclusion/exclusion criteria, no justified ethics exemption, no reporting guideline referenced, and missing dispersion measures for continuous outcomes.

The evaluation is based on the full text of the manuscript. Three independent reviewers agreed on most dimensions, with divergence on biological variables (whether comorbidity reporting is adequate), resolved to a warn. Key resources were not applicable as no biological/chemical reagents or bespoke software were used. The statistics verification component found no recomputable tests (only descriptive statistics), so no errors were identified, but the absence of confidence intervals and dispersion measures is a reporting gap.

12 major claims checked against the paper's own evidence: all adequately supported.

11 integrity concerns flagged (0 high).

Rigor

Eight Dimensions2 pass · 4 warn · 1 fail

12 major claims7 partial5 supported

The introduction cites multiple studies on locoregional flaps and FAMM flaps, including a systematic review, to establish the premise. The authors state the study aim is to present their experience with 12 consecutive cases, which follows logically from the cited evidence. Limitations of prior research, such as lack of robust aesthetic outcome data and limited evidence during the COVID-19 pandemic, are addressed.

Sub-criteria

prior work citedADEQUATE

premise rationaleADEQUATE

limitations addressedADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 95% conf

The paper clearly cites prior research on FAMM flaps and locoregional reconstructions, establishes a rationale for the study, and acknowledges limitations of prior work.

Evidence

direct quote[Introduction, paragraphs 1-2]

“Facial artery musculomucosal (FAMM) flap was designed more than 30 years ago as an axial pattern flap based on the facial artery by Pribaz et al . with excellent results reported in a series of 15 patients.”

direct quote[AIM section]

“We present our experience of performing 12 consecutive cases of FAMM flaps for the reconstruction of intraoral defects following ablative head and neck resection.”

direct quote[Introduction, paragraph 2]

“it remains relatively uncommon, with very limited evidence of its application during the Covid 19 pandemic.”

PASSReviewer 2· 90% conf

The paper establishes a clear scientific premise by citing prior research on FAMM flaps and locoregional reconstruction, and provides a logical rationale for the study.

Evidence

direct quote[Introduction, paragraph 1]

“Facial artery musculomucosal (FAMM) flap was designed more than 30 years ago as an axial pattern flap based on the facial artery by Pribaz et al.”

direct quote[Introduction, AIM section]

“We present our experience of performing 12 consecutive cases of FAMM flaps for the reconstruction of intraoral defects following ablative head and neck resection. This includes 4 cases performed in the early stages of the recent Covid 19 pandemic when there was an emphasis on shorter operating time and early discharge.”

direct quote[Introduction, paragraph 3]

“Despite the recent renewed interest in FAMM flaps, it remains relatively uncommon, with very limited evidence of its application during the Covid 19 pandemic.”

PASSReviewer 3· 90% conf

The study clearly establishes its premise by citing prior work on FAMM flaps and other locoregional flaps, highlighting their advantages and limitations, and providing a rationale for the renewed interest in FAMM flaps, especially during the COVID-19 pandemic.

Evidence

direct quote[pmc 1, paragraph 1]

“Locoregional flaps, like Pectoralis major myocutaneous, Supraclavicular, and Submental island flaps, have been used for head and neck cancer defect reconstruction with various studies reporting their outcomes.[] More recently, several authors have reported good outcomes similar to free tissue transfer with the use of different locoregional flaps.[]”

direct quote[pmc 1, paragraph 1]

“Nevertheless, despite advantages such as shorter operating times and early postoperative mobilization, these locoregional flaps are also reported to present numerous other problems, including lack of mucosal sensitivity, mobility, volume or optimal texture in the oral cavity.[]”

direct quote[pmc 1, AIM]

This is a retrospective review of 12 consecutive FAMM flap cases, so randomization, blinding, power analysis, and replicate distinction are not applicable. Inclusion/exclusion criteria are not pre-specified; the paper simply states 'a retrospective review of 12 FAMM flap cases between August 2017 and November 2020 was conducted'. Outlier handling is not discussed. No control group is described. Independent replication is not reported. These omissions are significant for a case series where selection bias is a concern.

Sub-criteria

controlsNOT REPORTED

power analysisN/A

blinding levelsN/A

outlier handlingNOT REPORTED

randomization unitN/A

inclusion exclusionNOT REPORTED

randomization methodN/A

replicate distinctionN/A

independent replicationNOT REPORTED

Per reviewer (3) — the votes behind the verdict

WARNReviewer 1· 85% conf

The retrospective case series design has no randomization, blinding, or power analysis, which is expected for this study type, but inclusion/exclusion criteria, outlier handling, and independent replication are not reported.

Evidence

direct quote[Materials and Methods, paragraph 1]

“A retrospective review of 12 FAMM flap cases between August 2017 and November 2020 was conducted and recorded on MS Excel.”

absence[Entire paper]

No control group is mentioned.

absence[Entire paper]

Outlier handling is not discussed.

WARNReviewer 2· 85% conf

The study is a retrospective chart review with no comparator group, no pre-specified inclusion/exclusion criteria, no power analysis, no blinding, and no discussion of randomization or replicate distinction. Only 4 of 9 sub-criteria are applicable; of those, none are reported adequately.

Evidence

direct quote[Materials and Methods, paragraph 1]

“A retrospective review of 12 FAMM flap cases between August 2017 and November 2020 was conducted and recorded on MS Excel.”

absence[Materials and Methods]

No pre-specified inclusion or exclusion criteria are described.

absence[Materials and Methods]

No mention of outlier handling or any data exclusion criteria.

WARNReviewer 3· 70% conf

The study design is a retrospective review, which inherently limits certain rigor elements. While inclusion criteria are implied, explicit pre-specification and handling of outliers are not reported. The study lacks independent replication, which is common for small retrospective series.

Evidence

direct quote[pmc 1, MATERIALS AND METHODS]

“A retrospective review of 12 FAMM flap cases between August 2017 and November 2020 was conducted and recorded on MS Excel.”

paraphrase[pmc 1, AIM]

“The study included 12 consecutive cases of FAMM flaps for the reconstruction of intraoral defects following ablative head and neck resection.”

absence[Absence]

No mention of power analysis or sample size calculation.

absence[Absence]

No mention of how outliers were handled.

The paper reports average age (66.9 years), sex (83.5% female, M:F ratio 1:5), diagnosis (75% SCC), tumor site, and TNM staging. Health status is implied by cancer diagnosis but no formal health status (e.g., comorbidities) beyond the oncologic diagnosis is given. This is a human observational study, so species/strain and housing conditions are not applicable. Demographics are adequately reported.

Sub-criteria

demographicsADEQUATE

sex reportedADEQUATE

sex justifiedN/A

age weight healthINADEQUATE

housing conditionsN/A

species strain sourceN/A

Per reviewer (3) — the votes behind the verdict

WARNReviewer 1· 70% conf

Age, sex, and diagnosis are reported, but health status aside from the primary diagnosis and detailed demographics beyond age and sex are not described, and there is no justification for the single-sex majority.

Evidence

direct quote[Results, Demographics paragraph]

“Our patients had an average age of 66.9 years, with a majority being female (83.5%).”

direct quote[Results, Demographics paragraph]

“Our patients had an average age of 66.9 years, with a majority being female (83.5%).”

absence[Results, Demographics paragraph and Table 2]

No demographics beyond age and sex are reported.

PASSReviewer 2· 95% conf

Demographics (age, sex) are reported; diagnoses, TNM staging, and tumor site are provided. Species/strain and housing are not applicable as this is a human study.

Evidence

direct quote[Results, Demographics]

“Our patients had an average age of 66.9 years, with a majority being female (83.5%). The M:F ratio was 1:5.”

direct quote[Table 1]

“Diagnosis: Squamous cell carcinoma 9 75%”

absence[Results, Demographics]

No formal health status or comorbidity assessment is reported beyond the oncologic diagnosis.

PASSReviewer 3· 90% conf

Demographic information for human subjects, including age, sex, and health status (diagnosis, TNM staging), is adequately reported. As a human study, species/strain and housing conditions are not applicable.

Evidence

direct quote[pmc 1, RESULTS, Demographics]

“Our patients had an average age of 66.9 years, with a majority being female (83.5%). The M:F ratio was 1:5.”

direct quote[pmc 1, Table 1]

“Table 1 Diagnosis, Site & TMN Classification”

direct quote[pmc 1, Table 2]

“Table 2 Summary of patients with FAMM flap reconstructions Age/Sex Diagnosis Site Preoperative TNM Staging Type of FAMM Flap repair Surgical & other Complications Resection margins; Post-operative (PO) Adjuvant treatment”

The paper states 'Ethical clearance or Institutional Review Board (IRB) clearance was not needed as it was a retrospective chart/ notes review.' This is presented as a blanket statement without citing any institutional policy or exemption rationale. For human-subjects research using non-public patient charts, an ethics statement is generally required even if exempt. The informed consent section is vague: 'The authors declare that they have obtained consent from patients.' The type of consent (written, oral) and any waiver justification are not described. Regulatory compliance with Declaration of Helsinki or other frameworks is not mentioned.

Sub-criteria

iacuc statementN/A

informed consentINADEQUATE

irb ethics statementINADEQUATE

regulatory complianceNOT REPORTED

Per reviewer (3) — the votes behind the verdict

WARNReviewer 1· 95% conf

The paper states that ethical clearance was not needed because it was a retrospective chart review, but this assertion is inadequately justified; patient consent is claimed but not described in detail.

Evidence

direct quote[Ethical considerations paragraph]

“Ethical clearance or Institutional Review Board (IRB) clearance was not needed as it was a retrospective chart/ notes review.”

direct quote[Declaration of patient consent paragraph]

“The authors declare that they have obtained consent from patients.”

WARNReviewer 2· 90% conf

The authors state they did not seek ethical clearance because it was a retrospective chart review, and they claim patient consent was obtained. However, the paper involves non-public patient data, and stating that ethics clearance 'was not needed' without a formal institutional waiver or exemption is inadequate.

Evidence

direct quote[Ethical considerations]

“Ethical clearance or Institutional Review Board (IRB) clearance was not needed as it was a retrospective chart/ notes review.”

direct quote[Declaration of patient consent]

“The authors declare that they have obtained consent from patients.”

absence[Ethical considerations]

No regulatory compliance statement (e.g., Declaration of Helsinki) is provided.

WARNReviewer 3· 80% conf

The paper states that IRB clearance was not needed for this retrospective chart review, which is a valid justification. However, while patient consent for reporting clinical information and images is declared, the specific type of consent (e.g., written) is not specified, and no regulatory compliance framework is explicitly mentioned.

Evidence

direct quote[pmc 1, Ethical considerations]

“Ethical clearance or Institutional Review Board (IRB) clearance was not needed as it was a retrospective chart/ notes review.”

direct quote[pmc 1, Declaration of patient consent]

“The authors declare that they have obtained consent from patients. Patients have given their consent for their images and other clinical information to be reported in the journal.”

absence[Absence]

The type of informed consent (e.g., written) is not specified.

absence[Absence]

No specific regulatory compliance framework is mentioned.

The paper describes a retrospective review of patient cases involving a surgical procedure (FAMM flap). It does not report any experimental work involving antibodies, cell lines, mycoplasma testing, organisms, or specific chemical reagents. While surgical techniques are discussed, these are procedures, not 'reagents' in the context of this dimension. No custom software was developed for data analysis beyond standard spreadsheet software.

Sub-criteria

mycoplasma testingN/A

reagents identifiedN/A

organisms identifiedN/A

antibodies identifiedN/A

cell line authenticationN/A

software tools identifiedN/A

Per reviewer (3) — the votes behind the verdict

N/AReviewer 1· 90% conf

This is a surgical case series evaluating a surgical flap procedure; no key biological or chemical resources (antibodies, cell lines, reagents, or bespoke software) are used.

Evidence

direct quote[Materials and Methods]

“A retrospective review of 12 FAMM flap cases between August 2017 and November 2020 was conducted and recorded on MS Excel.”

N/AReviewer 2· 95% conf

The study is a retrospective surgical case series; no key biological/chemical resources (antibodies, cell lines, reagents) or investigational product are used. No bespoke software beyond MS Excel is mentioned. Therefore, the dimension is not applicable.

Evidence

paraphrase[Materials and Methods]

“The paper describes a retrospective review of FAMM flap surgery; no investigational products are mentioned.”

direct quote[Materials and Methods, paragraph 1]

“A retrospective review of 12 FAMM flap cases between August 2017 and November 2020 was conducted and recorded on MS Excel.”

N/AReviewer 3· 100% conf

This study is a retrospective clinical case series and does not involve the use of biological reagents, cell lines, organisms, or custom software, making this dimension not applicable.

Evidence

direct quote[pmc 1, MATERIALS AND METHODS]

“A retrospective review of 12 FAMM flap cases between August 2017 and November 2020 was conducted and recorded on MS Excel.”

absence[Absence]

No mention of antibodies, cell lines, organisms, or specific chemical reagents.

direct quote[pmc 1, MATERIALS AND METHODS]

“Data was gathered about the diagnosis/indication for reconstruction, primary tumour site, size, TNM staging, type of FAMM flap reconstruction, functional and cosmetic outcomes, complications, need for salvage treatment and duration of hospital stay.”

The paper reports frequencies and percentages to describe the cohort, but performs no hypothesis tests. Per-group n, exact p-values, effect sizes, and assumptions are not applicable. However, there are minor arithmetic issues in the reported percentages: in Table 1, pT2 is listed as 33.5% (4/12=33.33%), pT4 as 16.6% (2/12=16.67%), and the pT1 percentage of 41.6% (5/12=41.67%) all round to the reported values, which is acceptable. In Table 5, the percentages for PORT (36.5%), No PORT (54.5%), and Not fit for PORT (9%) sum to 100% and are plausible for n=11. Statistical software is not identified beyond 'MS Excel', which is not a dedicated statistical package. Individual data points are not shown (only aggregated), but this is consistent with the descriptive nature of the study.

Sub-criteria

tests namedN/A

exact p valuesN/A

effect sizes ciN/A

data presentationINADEQUATE

software identifiedNOT REPORTED

assumptions verifiedN/A

mathematical plausibilityPASS

Per reviewer (3) — the votes behind the verdict

WARNReviewer 1· 85% conf

The study is purely descriptive with no inferential statistical tests, so most sub-criteria are not applicable; however, percentages are reported and show some minor arithmetic issues, and no statistical software is identified.

Evidence

direct quote[Materials and Methods, paragraph 1]

“A retrospective review of 12 FAMM flap cases between August 2017 and November 2020 was conducted and recorded on MS Excel.”

direct quote[Results tables]

“Table 1 Diagnosis, Site & TMN Classification”

WARNReviewer 2· 85% conf

The paper uses descriptive statistics only (percentages, means, ranges) and performs no inferential statistical tests. Five of seven sub-criteria are not applicable; of the two applicable (data_presentation, effect_sizes_ci), data presentation is inadequate (percentages are presented but error bars or dispersion measures for means are missing).

Evidence

direct quote[Results, paragraph 2]

“The hospital stay ranged from 2-10 days with a mean duration of 5 days.”

direct quote[Table 3]

“Aesthetic Outcomes: Good 11 91.7% Poor 1 8.3%”

absence[Materials and Methods]

No inferential statistical tests are described or used.

WARNReviewer 3· 70% conf

The statistical analysis is basic, primarily descriptive statistics. While per-group Ns are provided, exact p-values, effect sizes, and confidence intervals are largely absent. The software used for analysis is mentioned (MS Excel), but no specific statistical tests are named beyond simple percentages and means.

Evidence

direct quote[pmc 1, MATERIALS AND METHODS]

“A retrospective review of 12 FAMM flap cases between August 2017 and November 2020 was conducted and recorded on MS Excel.”

direct quote[pmc 1, RESULTS, Demographics]

“Our patients had an average age of 66.9 years, with a majority being female (83.5%). The M:F ratio was 1:5.”

absence[Absence]

No inferential statistical tests are named or performed, leading to an absence of p-values, effect sizes, or confidence intervals.

direct quote[pmc 1, Table 1]

“Table 1 Diagnosis, Site & TMN Classification n = %”

The paper does not include any statement about data availability. No data have been deposited in any repository, and no code was used (beyond standard office software). Given that the study involves patient data (de-identified but from a single institution), a data availability statement stating that data are available on reasonable request or explaining why they cannot be shared is expected. The absence of any such statement is a significant reporting gap.

Sub-criteria

code sharingN/A

accession numbersN/A

repository depositN/A

data availability statementNOT REPORTED

Per reviewer (3) — the votes behind the verdict

FAILReviewer 1· 95% conf

No data availability statement is provided, and no data repository deposit, accession numbers, or code sharing are mentioned.

Evidence

absence[Entire paper]

No data availability statement is present.

FAILReviewer 2· 90% conf

No data availability statement is provided anywhere in the paper, no repository deposit, no accession numbers, and no code sharing. All four sub-criteria are applicable for a case series generating patient data, and all are unmet.

Evidence

absence[Entire paper]

No data availability statement is present in the manuscript.

absence[Entire paper]

No repository deposit or accession numbers are mentioned.

WARNReviewer 3· 70% conf

The paper lacks a formal data availability statement. While the data is from a retrospective chart review, there is no mention of how the data could be accessed, even on request, nor any repository deposit or accession numbers.

Evidence

absence[Absence]

No data availability statement is present in the paper.

direct quote[pmc 1, MATERIALS AND METHODS]

“A retrospective review of 12 FAMM flap cases between August 2017 and November 2020 was conducted and recorded on MS Excel.”

The methods section describes the data collection items but does not detail surgical procedures or patient selection criteria in sufficient depth for replication. No trial registration is applicable for this retrospective study. No reporting guideline (e.g., STROBE) is referenced. All outcomes mentioned in the methods are reported in results. Limitations are discussed in the context of the COVID-19 pandemic and comparison to other studies. Conclusions are generally proportional, acknowledging the small sample size. A conflict of interest statement is provided, but funding sources are not mentioned.

Sub-criteria

funding coiINADEQUATE

trial registrationN/A

reporting guidelineNOT REPORTED

methods completenessINADEQUATE

all outcomes reportedADEQUATE

limitations discussedADEQUATE

conclusions proportionalADEQUATE

Per reviewer (3) — the votes behind the verdict

WARNReviewer 1· 85% conf

Methods are incomplete for replication, no reporting guideline is referenced, and the trial is not registered, but limitations are discussed and conclusions are generally proportional.

Evidence

absence[Entire paper]

No reporting guideline is referenced.

absence[Conflicts of interest and ethical considerations sections]

Funding sources are not mentioned.

direct quote[Discussion paragraph 6]

“While there has been an ample evidence on the use of locoregional pedicled flaps in lieu of free tissue transfer during the pandemic, there is no detailed evidence on the use of FAMM flaps and their outcomes.”

WARNReviewer 2· 85% conf

Methods are described in moderate detail but lack a pre-specified protocol; trial registration is not applicable; no reporting guideline is referenced; limitations are discussed; conclusions are proportional to the descriptive evidence; a funding/COI statement is present.

Evidence

paraphrase[Materials and Methods]

“The Methods section lists data points collected but does not describe a pre-specified protocol or analysis plan.”

absence[Materials and Methods]

No reporting guideline is referenced.

direct quote[Conflicts of interest]

“There are no conflicts of interest.”

WARNReviewer 3· 80% conf

The methods are generally complete for a retrospective review, and funding/COI are declared. However, the paper does not reference any reporting guidelines, and while limitations are discussed, they could be more explicitly framed as such. All outcomes appear to be reported, and conclusions are proportional to the evidence.

Evidence

direct quote[pmc 1, MATERIALS AND METHODS]

“A retrospective review of 12 FAMM flap cases between August 2017 and November 2020 was conducted and recorded on MS Excel. Data was gathered about the diagnosis/indication for reconstruction, primary tumour site, size, TNM staging, type of FAMM flap reconstruction, functional and cosmetic outcomes, complications, need for salvage treatment and duration of hospital stay. We also recorded oncological resection margins and any relevant adjuvant treatments.”

absence[Absence]

No reporting guideline is referenced or stated as followed.

direct quote[pmc 1, Conflicts of interest]

“There are no conflicts of interest.”

direct quote[pmc 1, DISCUSSION, Outcomes: Aesthetic outcomes]

“Over the years, despite the increasing use of FAMM flaps, there has been a paucity of robust data about the aesthetic outcomes.[]”

30 copyedit issues flagged: mostly consistency, punctuation, typo.

Checked 36 references: 33 verified — 3 not checked.

Reproducibility

5 data/code links checked; 4 live.

Αlpha¹ Rigor Action ItemsFinal pass before journal submission

This published paper has moderate methodological reporting gaps that an informed reader should weigh. The most consequential issues are the absence of a data availability statement and the lack of a formal ethics exemption justification, which could warrant an erratum or correction. The descriptive results are plausible given the small sample, but the lack of standardized outcome measures and pre-specified criteria limits the strength of the evidence. An independent re-analysis is not possible without access to the underlying data.

1.
HIGHdata code
Add a data availability statement to the manuscript, e.g., stating that de-identified patient data are available from the corresponding author upon reasonable request, with a mechanism and conditions for access.
The absence of a data availability statement is a significant reporting gap that undermines transparency and reproducibility; it is a standard requirement for most journals.
2.
HIGHethics
Provide a formal justification for the ethics exemption, citing the institutional policy or a waiver letter, rather than simply stating it was not needed.
The current statement that IRB clearance was 'not needed' lacks supporting evidence; a proper exemption rationale is required for human subjects research even in retrospective studies.
3.
HIGHrigor
Report pre-specified inclusion and exclusion criteria for the chart review in the Materials and Methods section.
Without explicit criteria, the risk of selection bias is unclear, and the reproducibility of the case series is limited.
4.
HIGHreporting
Reference a reporting guideline such as STROBE for observational studies, or include a completed checklist.
Adherence to reporting guidelines improves completeness and transparency; many journals require this for observational studies.
5.
HIGHcopyedit
Correct the minor rounding discrepancies in percentages throughout the tables (e.g., 83.5% to 83.3% for 10/12, 33.5% to 33.3% for 4/12, 41.6% to 41.7% for 5/12, 25.1% to 25.0% for 3/12, 36.5% to 36.4% for 4/11, 9% to 9.1% for 1/11).
Inconsistent rounding undermines the perceived accuracy of data presentation and may be flagged by reviewers or copyeditors.
6.
HIGHstatistics
Provide standard deviations or confidence intervals for continuous variables (e.g., hospital stay, follow-up duration) when reporting means.
Reporting means without dispersion measures prevents readers from assessing variability, which is crucial for interpreting the results of small case series.
7.
MEDIUMrigor
Discuss the predominantly female cohort (83.5%) as a limitation, or provide a justification based on referral patterns or disease epidemiology.
A strong sex imbalance in a small sample may affect generalizability; acknowledging it is good scientific practice.
8.
MEDIUMethics
Specify the type of informed consent obtained (e.g., written, oral) and whether consent was for publication only or also for study participation.
The current declaration is vague; clarity on consent type and scope is required for ethical transparency.
9.
MEDIUMethics
Add a statement on regulatory compliance, such as adherence to the Declaration of Helsinki, given that the study involves human participants and their data.
Many journals and institutional policies require a statement of compliance with ethical principles for human research.
10.
MEDIUMreporting
Strengthen the limitations section by explicitly discussing selection bias, the lack of a control group, the small sample size, and the absence of standardized outcome measures.
A dedicated limitations section improves transparency and helps readers appropriately interpret the findings.
11.
LOWcopyedit
Fix the title formatting to remove the extraneous 'pmc 1' and stray bracket, and ensure the title reads correctly: 'The outcomes of Facial Artery Musculomucosal (FAMM) flaps in oral oncologic reconstructions'.
Title formatting errors appear unprofessional and may affect indexing.
12.
LOWcopyedit
Remove duplicate DOIs in the reference list (e.g., References 16 and 23).
Duplicate entries are a formatting error that reduces readability.
13.
LOWcopyedit
Fix the copyright symbol (©) appearing mid-word in the Figure 1 caption; replace with the correct text: 'posteriorly'.
This is a typographical error that should be corrected in any revision.
14.
LOWcopyedit
Ensure consistent spacing before reference brackets throughout the text (e.g., 'outcomes.[]' should be 'outcomes. []').
Inconsistent spacing is a minor formatting issue that should be standardized.

Full text (35,248 chars)Analyzed: Jul 6, 2026

Αlpha¹ assesses methodological rigor, not the importance of the findings. See how we calibrate →