Composite submental flaps in facial reconstructive surgery involving the zygoma and orbit

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.

Resurgence of regional flaps for head and neck reconstruction

PURPOSE OF REVIEW

The strain on healthcare resources in light of the COVID-19 pandemic has forced many head and neck surgeons to explore reconstructive options that may decrease length of stay. Here, we review three common and versatile regional flaps used in head and neck reconstruction that are comparable alternatives to free tissue transfer.

RECENT FINDINGS

Initial anatomic descriptions of the facial artery musculocutaneous (FAMM) flap, the supraclavicular artery island flap and the submental artery island flap were published decades ago. Since then, many have proposed modifications to these descriptions to improve technical ease and patient outcomes. Benefits of regional flaps include ease of harvest, comparable outcomes to free tissue microvascular flaps, shorter operative time and hospital length of stay. Drawbacks to regional flaps include limitations to size and reach, partial necrosis, wound dehiscence and surgeon experience. The integrity of the vascular pedicle is also contingent upon vessel preservation during the cancer ablation.

SUMMARY

Although a resurgence of regional flaps began well before the COVID-19 pandemic, many institutions began looking for alternatives to free flap reconstruction to conserve healthcare resources and minimize patient hospitalization time in the past year. There has been a revival of regional flaps such as the FAMM, supraclavicular and submental flaps that are valuable reconstructive options for many defects of the head and neck.