To investigate the clinical application of free skin flap in the one-stage repair and reconstruction after total glossectomy in patients with advanced tongue cancer. Twenty-eight patients who underwent total glossectomy for advanced tongue cancer and treated with the one-stage repair and reconstruction with free skin flap ranged from January 2008 to July 2018 were recruited in this study. Among them, there were 12 cases of squamous cell carcinoma, 8 cases of adenocarcinoma, and 8 cases of adenoid cystic carcinoma. The free radical forearm flap and perforator flap of posterolateral peroneal calf peroneal artery were used in 16 and 12 cases, respectively. All patients were treated with outpatient functional rehabilitation sequence and postoperative radiotherapy within 6 months, and were followed up regularly for 1, 3 and 5 years to understand their living conditions, and Washington University students’ quality questionnaire 4 was used to investigate the functional factors of the healthy patients in different periods of time after surgery. The survival rate of the free skin flap was 94%. The radical forearm flap was immediately changed to perforator flap posterolateral peroneal calf peroneal artery in 2 cases due to the necrosis of the artery. The hospitalization time of the patients was 10-14 days, with an average of 12.5 days. The wounds inside and outside of the mouth were healed by first intention at the time of discharge. All nasogastric tube and tracheal tube were removed safely within 45 days after the surgery and the functions of swallowing, breathing, language and chewing were gradually restored. According to the questionnaire survey, patients’ attention to quality of life gradually shifted from function to feeling. With the direct calculation method, the 1-,3-, and 5-year survival rate was 96.40%, 64.71%, 55.60%, respectively, while tumor-free survival rate was 85.70%, 58.82%, 55.60%, respectively. The comprehensive treatment based on free tissue flap repair and reconstruction of tissue defects can significantly improve the radical cure rate of patients with advanced tongue cancer, and can effectively restore the functions of swallowing, breathing, language, chewing and so on. It is a kind of treatment method worthy of promotion.Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.