Submental island flap reconstruction for carcinoma of the oral cavity: Experience in 30 cases

Sonographic Evaluation of the Submandibular Region and Perforators Mapping Before Harvesting a Submental Flap May Reduce Vascular-Related Complications

The submental flap (SF) may serve as an alternative to free flap microvascular reconstruction in the head and neck region for appropriately selected patients. However, despite its apparent simplicity, the SF can be associated with a significant incidence of vascular complications affecting the transferred tissues. The aim of this study was to evaluate the usefulness of preoperative color Doppler ultrasonography (CDU) in planning the submental flap. A total of 62 patients with oral cavity cancers who underwent reconstruction using the submental flap were included. In the first group, perforators and the vascular course were assessed preoperatively using CDU. The second group comprised retrospectively selected patients who did not undergo preoperative perforator mapping. Perforators were most commonly located lateral to the digastric muscle. We observed a lower overall incidence of flap perfusion disorders in patients who underwent CDU evaluation (6 versus 1; P=0.105). Moreover, these patients required fewer reoperations. In conclusion preoperative sonographic assessment of the submandibular region should be performed on all patients for whom SF reconstruction is planned. This approach enables precise identification of vessels and their trajectories, facilitating safer and more efficient flap elevation.

Submental island flap versus supraclavicular island flap in oral tongue cancer reconstruction: Perioperative and functional outcomes

BACKGROUND

The primary treatment for oral tongue cancer in both early and advanced stages involves surgical resection, which often affects tongue function. When microvascular free flaps are unsuitable for tongue reconstruction following cancer ablation, locoregional pedicled flaps become viable alternatives, for example, submental and supraclavicular island flaps. This study compares perioperative and functional outcomes between submental and supraclavicular flaps in tongue cancer reconstruction.

METHODS

This retrospective cohort study analyzed the outcomes of 46 patients who underwent tongue resection and reconstruction with a submental or supraclavicular island flap between January 2015 and December 2022. We evaluated patient demographics, flap outcomes, postoperative complications, and speech and swallowing outcomes.

RESULTS

The study included 24 submental and 22 supraclavicular island flap reconstructions. While demographic data were similar between the two groups, the submental island flap group had significantly shorter operative times than the supraclavicular group (291 and 347 min, respectively, p = 0.018), reduced hospital stays (14.8 and 18.6 days, respectively, p = 0.016), fewer major recipient site complications necessitating interventions under general anesthesia (1 and 6 patients, respectively, p = 0.043), and less recipient wound dehiscence (1 and 8 patients, respectively, p = 0.009). Speech and swallowing outcomes were comparable in the two groups.

CONCLUSION

The submental island flap appears to be a more favorable option for tongue reconstruction than the supraclavicular island flap, offering advantages in operative time, length of hospital stays, and lower rates of major complications and wound dehiscence.

Efficacy of submental island flap closing advanced mandibular MRONJ lesion in malignancy patients

OBJECTIVE

This study evaluated the effectiveness of a submental island flap in closing advanced mandibular medication-related osteonecrosis of the jaw (MRONJ) wounds in patients with malignant tumors.

SUBJECTS AND METHODS

A total of 85 patients with stage II and III MRONJ of mandible with malignant tumor as their primary disease were retrospectively analyzed. All patients underwent surgical treatment, and the soft tissue wound closure was performed either with a submental island flap (SIF) or mucoperiosteal flap (MF). Univariate and multifactorial models were applied to analyze the factors influencing patients' prognosis.

RESULTS

Univariate analysis (p = 0.004, OR 0.075-0.575, 95% CI) and binary logistic regression (p = 0.017, OR 0.032-0.713, 95% CI) suggested that the surgical prognosis of SIF wound closure was significantly better than that of MF.

CONCLUSION

Closure of wound after resection of mandibular MRONJ lesions in patients with malignant tumors using SIF had a better clinical prognosis compared with MF.

The reliability of submental flap for soft tissue reconstruction in patients with carcinoma of the oral cavity

BACKGROUND

The submental island flap (SIF) is a reliable option for reconstruction of the defects of the oral cavity following cancer resection. Advantages include reliable axial vascular pedicle, low donor site morbidity, good functional and cosmetic outcome, shorter operative time and lower cost compared to free flap reconstruction.

MATERIALS AND METHODS

A total of 32 consecutive patients with carcinoma of the oral cavity were included in this study. All patients underwent resection and immediate reconstruction with SIF pedicled the submental vessels. Donor and recipient site morbidity, functional outcome, and locoregional recurrences are reported.

RESULTS

The study included 22 males (69%) and 10 females. The mean age was 54 years (range of 31-79 years). The most common primary tumor site was the tongue (15 patients, 47%), followed by the buccal mucosa, alveolar margin, floor of mouth, lower lip and hard palate. In 25 patients (78%) the flap survived completely. Complete flap loss occurred in one patient (3%). Six patients (19%) developed complications related to flap vascularity. 21 patients (66%) resumed normal diet, while 11 patients (34%) tolerated only soft diet. Over a median follow up was of 15 months (range of 3-62 months), 21 patients (66%) are alive and disease free, while 8 patients died, of whom 4 of locoreginal recurrences.

CONCLUSIONS

SIF is reliable for reconstruction of the intraoral soft tissue defects following cancer resection. The functional and cosmetic outcomes are satisfactory and donor site morbidity is low. Careful patient selection is necessary for favorable outcome.

Repair of postoperative defects of oral cancer with submental island flaps based on vascular pedicles of different states: a multicenter retrospective study

Submental island flap has certain advantages in repairing postoperative defects of oral cancer, and it can often achieve similar or even better effects compared with those of the free tissue flap. In this study, according to the different characteristics of patients and postoperative defects of oral cancer, submental island flaps with different states of vascular pedicle were prepared, and its repair methods, safety, and clinical effects in treating postoperative defects of oral cancer were investigated. 83 patients with oral cancer who met the inclusion criteria were selected. According to the different characteristics of the patients and postoperative defects of oral cancer, the traditional submental island flap vascular pedicle was modified into three different states: submental artery perforator flap, vascular pedicled flap with the anterior belly of digastric muscle but without the submandibular gland (SIF with anterior belly of DM), and vascular pedicled flap with the anterior belly of the digastric muscle and the submandibular gland (SIF with anterior belly of DM and SG). The types of the submental artery and the drainage vein, flap survival, and complications, were observed. The flap was successfully harvested for all patients, and the submental artery could be found or separated for all of them, with the venous drainage to the internal jugular vein in 57 (57/83, 68.67%), to the external jugular vein in 18 (18/83, 21.69%), and to the anterior jugular vein in eight (8/83, 9.64%) cases. Submental artery perforator flap was used for 11 cases, complete necrosis occurred in two cases (2/11, 18.18%), partial necrosis occurred in one case (1/11, 9.09%); SIF with anterior belly of DM was used for 49 cases, complete necrosis occurred in one case (1/49, 2.04%), partial necrosis occurred in four cases (4/49, 8.16%); SIF with anterior belly of DM and SG was used for 23 cases, including chimeric flap combining the submental island flap and the submandibular gland used for 15 cases, there were no cases of complete or partial necrosis. Submental island flap was effective in repairing postoperative defects of oral cancer. Submental island flaps with three different states of vascular pedicle could repair oral cancer-affected tissues with different defect characteristics.

Tongue Reconstruction After Hemiglossectomy Due to Cancer by Submental Flap: A Case Series

We report three clinical cases using a submental flap to reconstruct the half-tongue defects after tongue cancer surgery at Hue Central Hospital (Hue city, Vietnam). The size of the flap ranged 30–60mm. The time to take flap ranged 50–60 minutes. All three patients did not have liquid accumulation, wound infection and bleeding after surgery; the flap survived well. All patients were taken the nasogastric tube out after ten days and discharged after two weeks. Postoperative functional (speech, swallowing) and tongue aesthetic assessments (symmetry) were good. These cases highlight that the submental flap is a choice for patients with flaws in the tongue. It ensures both functional and aesthetic for the regenerative tongue and donor site.

Reconstruction of lower and midfacial soft tissue defects with a submental island flap

This study aims to analyze the feasibility and utility of a submental island flap and to identify whether this flap procedure is a good choice for the reconstruction of lower and midfacial soft-tissue defects. This was a retrospective study that included 12 patients with lower and midfacial soft tissue defects, which were reconstructed using the submental island flap technique. The medical records of 12 patients who underwent reconstruction with submental island flaps from September 2015 to September 2020 were reviewed and included 11 patients with skin cancer and 1 patient with a history of trauma. The mean age of the patients was 64.9 years. The details of the flap harvest were studied for flap size, the procedure to elevate the flap, pedicle flow, and flap survival rate. In addition, information on demographics, histology, location, size, recurrence, and outcomes was recorded. All of the flaps survived. The skin paddle size ranged from 22 to 55 cm² (mean size 33 cm²). Ten flaps were anterograde pedicle flaps and two flaps were retrograde pedicle flaps. All donor sites were closed using primary closure without any difficulty in neck movement. None of the patients had symptoms of postoperative facial palsy. There were no signs of any local or regional cancer recurrence. The mean follow-up time was 22.9 months. There was an esthetic appearance of graft sites. The submental island flap is a feasible and reliable option for the reconstruction of lower and midfacial defects, which provides good cosmetic results.

The submental flap: Be wary

The submental island flap (SIF) is as an alternative to free flaps in head and neck reconstruction. 10 patients underwent submental flaps. All ten patients suffered failure of SIF as the definitive reconstructive procedure. Despite comparing favorably to free tissue transfer in published reports, our SIF had high failure rate.

Oncologic safety of submental island flap reconstruction in clinically node-negative oral cancer patients: a prospective comparative study

The purpose of this study was to evaluate the oncologic safety of submental island flap (SIF) reconstruction in clinically node-negative oral cancer patients. Forty-four clinically node-negative oral cancer patients with tumour size T1-T3 were divided into two groups. The Submental group consisted of 21 patients, who underwent submental island flap reconstruction whereas the control group consisted of 23 patients who underwent reconstruction with other locoregional or free flaps. The locoregional recurrence rate (LRR) and recurrence-free survival (RFS) in these two groups were assessed and compared. The follow-up period in the two groups ranged from six to 28 months, with a median follow-up period of 15 months and 21 months, respectively. Results showed that the LRR in the control and the submental group was 21.7% and 19%, respectively (p = 0.825). Kaplan-Meier curve showed that the difference in recurrence-free survival in the two groups was not statistically significant (p = 0.749). Multivariate and bivariate analyses did not establish any relationship between the predictive parameters and locoregional recurrence. Thus, the Submental island flap is a reliable and versatile locoregional flap for the reconstruction of post-resection defects in oral cancer. It has no predictive influence on locoregional recurrence in clinically node-negative oral cancer patients.