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The internal oblique muscle free flap, based on the deep circumflex iliac artery, has emerged as a valuable option for oral reconstruction, due to its flexibility and the option to use it as a composite flap with iliac crest bone, for simultaneous bone and soft tissue reconstruction. However, clinical studies on the epithelialization process and factors influencing healing are limited. This retrospective study was performed to analyse the healing process in 29 patients who underwent reconstruction using internal oblique muscle free flaps following oral cancer resection at Chosun University Dental Hospital, between 2013 and 2022. Clinical photographs were evaluated to determine the times to epithelialization and surface maturation. The mean time to epithelialization was 5.6 ± 1.6 weeks, while surface maturation required 19.4 ± 10.9 weeks. Tongue defects showed the longest surface maturation period (30.3 weeks) and floor of the mouth defects the shortest (11.3 weeks), although there was no significant difference in this period between the various lesion sites. Pearson correlation revealed a strong positive relationship between time to epithelialization and time to surface maturation (r = 0.530, P = 0.003). Secondary trimming procedures were necessary in eight (27.6%) patients and significantly prolonged both epithelialization (P = 0.016) and surface maturation (P = 0.003). Age, lesion size, and other clinical variables did not significantly affect healing. The internal oblique muscle free flap demonstrated excellent outcomes with a 97.2% success rate and predictable healing patterns. This study established important healing benchmarks for patient counselling in oral reconstruction.