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Submental flap: no longer a sinister flap—technique and long-term oncological outcomes

  • Original Paper
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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Submental flap is an important addition to the armamentarium of the head and neck surgeon, due to its simple technique. However, its popularity has failed to lift off due to its alleged inferior oncological outcomes and presumed precarious blood supply. This study aimed to report the technique and long-term oncological outcomes of this under-appreciated flap.

Methods

A total of 38 patients with oral cavity cancers were included in the study 2012 to August 2019 in a tertiary care referral hospital. Submental island flap was utilised for the reconstruction of the soft-tissue defect in each patient. The site and stage of the tumour, type of resection, were recorded and the patients were followed up to assess the status of the flap and its donor site and the oncologic outcomes.

Results

There were 23 men and 15 women, with a mean ageof 56.94 (39–73) years . All, but one patient, underwent neck dissection. The median lymph node yield was 18. The median follow-up of the cohort was 38.15 months (7.2–96.3months).

Conclusions

The submental flap is a dependable option for oral cancer reconstruction in carefully selected cases, with acceptable morbidity and long-term oncological results.

Level of evidence: Level IV, therapeutic study.

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References

  1. Daniel RK, Taylor GI (1973) Distant transfer of an island flap by microvascular anastomoses: a clinical technique. Plast Reconstr Surg 52(2):111–117

    Article  CAS  Google Scholar 

  2. Futran ND, Mendez E (2006) Developments in reconstruction of midface and maxilla. Lancet Oncol 7(3):249–258

    Article  Google Scholar 

  3. Ariyan S (1979) The pectoralis major myocutaneous flap: a versatile flap for reconstruction in the head and neck. Plast Reconstr Surg 63(1):73–81

    Article  CAS  Google Scholar 

  4. Apostolakis LW, Funk GF, Urdaneta LF, McCulloch TM, Jeyapalan MM (2001) Midface reconstruction: surgical reconstruction versus prosthesis. Head Neck 23(1):48–58

    Article  Google Scholar 

  5. Suh JD, Sercarz JA, Abemayor E, Calcaterra TC, Rawnsley JD, Alam D, Blackwell KE (2004) Analysis of outcome and complications in 400 cases of microvascular head and neck reconstruction. Arch Otolaryngol Head Neck Surg 130(8):962–966

    Article  Google Scholar 

  6. Singh B (1999) Factors associated with complications in microvascular reconstruction of head and neck defects. Plast Reconstr Surg 103(2):403–411

    Article  CAS  Google Scholar 

  7. Disa JJ, Pusic AL, Hidalgo DA, Cordeiro PG (2003) Microvascular reconstruction of the hypopharynx: defect classification, treatment algorithm, and functional outcome based on 165 consecutive cases. Plast Reconstr Surg 111(2):652–660

    Article  Google Scholar 

  8. Mahieu R, Colletti G, Bonomo P et al (2016) Ricostruzioni del distretto testa collo con lembi peduncolati nell’era dei lembi liberi. Acta Otorhinolaryngol Ital 36(6):459–468

    Article  CAS  Google Scholar 

  9. Martin D, Pascal JF, Baudet J, Mondie JM, Farhat BJ, Athoum A, le Gaillard P, Peri G (1993) The submental island flap: a new donor site anatomy and clinical applications as a free or pedicled flap. Plast Reconstr Surg 92(5):867–873

    Article  CAS  Google Scholar 

  10. AA F, RJ Y (1996) The submental artery flap: an anatomic study. Plast Reconstr Surg 97(1). https://doi.org/10.1097/00006534-199601000-00008

  11. Pistre V, Pelissier P, Martin D, Lim A, Baudet J (2001) Ten years of experience wih the submental flap. Plast Reconstr Surg 108(6):1576–1581

    Article  CAS  Google Scholar 

  12. Tassinari J, Orlandino G, Fabrizio T, Calabrese L (2010) Submental flap in facial reconstructive surgery: long-term casuistry revision. Plast Reconstr Surg 126(3). https://doi.org/10.1097/PRS.0b013e3181e3b570

  13. Chow TL, Chan TTF, Chow TK, Fung SC, Lam SH (2007) Reconstruction with submental flap for aggressive orofacial cancer. Plast Reconstr Surg 120(2):431–436

    Article  CAS  Google Scholar 

  14. Sebastian P, Thomas S, Varghese BT, Iype EM, Balagopal PG, Mathew PC (2008) The submental island flap for reconstruction of intraoral defects in oral cancer patients. Oral Oncol 44(11):1014–1018

    Article  Google Scholar 

  15. Genden EM, Buchbinder D, Urken ML (2004) The submental island flap for palatal reconstruction: a novel technique. J Oral Maxillofac Surg 62(3):387–390

    Article  Google Scholar 

  16. Demir Z, Kurtay A, Şahin Ü, Velidedeoǧlu H, Çelebioǧlu S (2003) Hair-bearing submental artery island flap for reconstruction of mustache and beard. Plast Reconstr Surg 112(2):423–429

    Article  Google Scholar 

  17. Kim JT, Kim SK, Koshima I, Moriguchi T (2002) An anatomic study and clinical applications of the reversed submental perforator-based island flap. Plast Reconstr Surg 109(7):2204–2210

    Article  Google Scholar 

  18. Amin AA, Sakkary MA, Khalil AA, Rifaat MA, Zayed SB (2011) The submental flap for oral cavity reconstruction: extended indications and technical refinements. Head Neck Oncol 3(1):51

    Article  Google Scholar 

  19. Rahpeyma A, Khajehahmadi S (2014) Submental artery island flap in intraoral reconstruction: a review. J Cranio-Maxillofacial Surg 42(6):983–989

    Article  Google Scholar 

  20. Faisal M, Adeel M, Riaz S, Anwar A, Rashid A, Usman S, Jamshed A, Hussain R (2018) The submental island flap in head and neck cancer. Ann Maxillofac Surg 8(2):287–291

    Article  Google Scholar 

  21. Abouchadi A, Capon-Degardin N, Patenôtre P, Martinot-Duquennoy V, Pellerin P (2007) The submental flap in facial reconstruction: advantages and limitations. J Oral Maxillofac Surg 65(5):863–869

    Article  Google Scholar 

  22. Rahpeyma A, Khajehahmadi S (2014) Submental artery island flap in intraoral reconstruction: a review. J Craniomaxillofac Surg 42(6):983–989

    Article  Google Scholar 

  23. Sterne GD, Januszkiewicz JS, Hall PN, Bardsley AF (1996) The submental island flap. Br J Plast Surg 49(2):85–89

    Article  CAS  Google Scholar 

  24. Merten SL, Jiang RP, Caminer D (2002) The submental artery island flap for head and neck reconstruction. ANZ J Surg 72(2):121–124

    Article  CAS  Google Scholar 

  25. Pradhan P, Samal S, Samal DK, Preetam C, Parida PK (2019) Submental island flap reconstruction for carcinoma of the oral cavity: experience in 30 cases. World J Otorhinolaryngol - Head Neck Surg 5(2):65–70

    Article  Google Scholar 

  26. Parmar PS, Goldstein DP (2009) The submental island flap in head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg 17(4):263–266

    Article  Google Scholar 

  27. Howard BE, Nagel TH, Donald CB, Hinni ML, Hayden RE. Oncologic safety of the submental flap for reconstruction in oral cavity malignancies. In: Otolaryngology - Head and Neck Surgery (United States). Vol 150. Mosby Inc.; 2014:558-562. https://doi.org/10.1177/0194599814520687

  28. Paydarfar JA, Patel UA (2011) Submental island pedicled flap vs radial forearm free flap for oral reconstruction: comparison of outcomes. Arch Otolaryngol Head Neck Surg 137(1):82–87

    Article  Google Scholar 

  29. McLean JN, Carlson GW, Losken A (2010) The pectoralis major myocutaneous flap revisited: a reliable technique for head and neck reconstruction. Ann Plast Surg 64(5):570–573

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Acknowledgements

The authors thank Dr Aparna Das, Junior Resident, Department of Otorhinolaryngology, JIPMER, for the illustrations.

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Authors and Affiliations

  1. Department of Surgical Oncology, JIPMER, Puducherry, 605006, India

    Prasanth Penumadu & Pavneet Kohli

  2. Department of Plastic Surgery, JIPMER, Puducherry, 6050006, India

    Meethale Thiruvoth Friji

  3. Department of Surgical Oncology, Sree Gokulam Medical College and Research Foundation, Thiruvananthapuram, Kerala, India

    Saheer Neduvanchery

Authors
  1. Prasanth Penumadu
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  2. Pavneet Kohli
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  3. Meethale Thiruvoth Friji
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  4. Saheer Neduvanchery
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Contributions

Prasanth Penumadu (PP) was responsible for study concepts. Study was designed by Pavneet Kohli (PSK) and PP. Data acquisition was done by Saheer Neduvanchery (NS). Quality control of data was done by Friji MT (FMT). PP and PSK performed data and statistical analysis and its interpretation. PSK and PP and prepared the manuscript and edited it. PP and FMT reviewed the manuscript. All authors approved the final manuscript for submission.

Corresponding author

Correspondence to Prasanth Penumadu.

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Ethical statement

The authors confirm that all accepted principles of ethical and professional conduct have been met. The manuscript has been read and approved by all the authors and each author believes that the manuscript represents honest work.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Institutal Ethics Committee Observational studies, JIPMER (IEC Protocol No. JIP/IEC/2020/347).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Patient consent

Patients signed informed consent regarding publishing their data and photographs

Conflict of interest

Prasanth Penumadu, Pavneet Kohli, Friji MT and Saheer Neduvanchery declare no competing interests.

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Penumadu, P., Kohli, P., Friji, M.T. et al. Submental flap: no longer a sinister flap—technique and long-term oncological outcomes. Eur J Plast Surg 44, 763–770 (2021). https://doi.org/10.1007/s00238-021-01807-3

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  • DOI: https://doi.org/10.1007/s00238-021-01807-3

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