Management of different kinds of head and neck defects with the submental flap for reconstruction

The submental island flap in head and neck reconstruction: A 10-year experience examining application, oncologic safety, and role of comorbidity

Background

We present our experience on reconstructive versatility and risk of nodal transfer with the submental island flap (SIF). We also examine the role of comorbidity as a predictor of complications.

Methods

Retrospective cohort study of patients undergoing SIF over 10-year period. Comorbidity determined using Adult Comorbidity Evaluation 27 index (ACE-27). Univariable/multivariable logistic regressions performed to determine association of these characteristics and rates of major complications.

Results

Fifty-eight patients underwent SIF reconstruction, 27 (45%) patients had moderate/severe comorbidity, and 24 (41%) experienced major complication. Multivariable analysis identified ACE-27 scores >2 predictive of major flap complications (OR: 17.38, 95% CI: 1.96-153.74, p = .01) and medical complications (OR: 5.8, 95% CI: 1.11-30.23, p = .037). There were no cases of pathologic nodal transfer.

Conclusion

The SIF is a versatile flap and oncologically safe in carefully selected patients. The ACE-27 index is strongly predictive of major postoperative complications.

Level of Evidence

4.

Donor Site Morbidity in Submental Flap: Emphasizing on Facial Hairs Direction

Introduction

Donor site morbidity is an important factor for selecting a flap for reconstruction. Submental flap using submentum skin for reconstruction has low donor site morbidity. Up to now, donor site morbidity of submental flap in Caucasians has not been evaluated.

Materials and Methods

In a retrospective study, donor site morbidity of the submental flap including changes in hair direction, hypertrophic scars, and suture marks was evaluated.

Results

Forty patients with at least 2 years of follow-up were evaluated. Female patients indicated better esthetic results. Abrupt beard hair direction change occurred in five male patients. Two hypertrophic scars and one suture mark were recorded.

Conclusion

The direction of beard hairs in submentum may be changed after submental flap harvest. Accordingly, this is important in some ethnic and religious groups.

Reconstruction with submental flap for aggressive orofacial cancer- an updated series

PURPOSE

Submental flap is gaining popularity for head and neck reconstruction. We have reported in 2007 our early experience of using submental flap for aggressive orofacial malignancy. Novel flap design and application is described in this updated series.

MATERIALS AND METHODS

15 patients who had received submental flap reconstruction after extirpation of newly diagnosed aggressive orofacial lesions were retrieved. The details of the flap harvest was studied for flap size, inclusion of mylohyoid muscle, antegrade versus retrograde blood supply, and compared with our previous series.

RESULTS

The dimension of flap skin paddle was 30cm² (range 20-72). Retrograde pedicle flow was used in 2(13.3%) patients. Mylohyoid muscle was included in the flap in 6(40%) patients. There was no total flap necrosis while partial flap necrosis occurred in 1 patient(6.7%). There was a significant increase of inclusion of mylohyoid muscle to the flap in this series (p = 0.02). Novel techniques including double-paddled flap skin to resurface full-thickness defect and chimeric osteocutaneous mandible submental flap for maxillary defect were successfully performed.

CONCLUSIONS

Submental flap is a viable reconstructive option in selected patients with aggressive orofacial malignancy. The indications are expanding and its technical modification is evolving and resulting in more innovative applications.

Novel case examples of the submental island flap in pediatric head and neck reconstruction

The submental island flap was first described as a tool for facial reconstruction after tumor resection. It is now widely used for reconstructing numerous structures in the head and neck region of adults. Pediatric surgical reconstruction is a challenging task that continues to evolve over time. We describe two novel uses of this flap in the pediatric population. The submental island flap is an excellent option for reconstruction in pediatrics given its ease of elevation, excellent cosmetic outcomes, and low donor site morbidity.