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Refinements of the submental island flap donor site: a literature review and comparison among surgical specialties



Since the description of the submental island flap as an alternative flap for reconstructing the lower third of the face, clinical and experimental studies have shown a great versatility in its design. However, just a few advancements in donor site morbidity have been reported if compared to other workhorse flaps. In this presented study, we aimed to analyze what factor influences higher morbidity and poor cosmesis at the donor site.


A literature search was conducted on EMBASE, Google Scholar, MEDLINE, and Cochrane Library databases. Search terms included  submental island flap and submental flap. Identified articles were screened and checked for eligibility by two authors independently.


The average flap size was 11 × 5 cm, and malignancy was the primary etiology. Overall complications were present in 17.5% of patients. However, donor site complication was present in only 3.9% of patients. Temporary paresis of the mandibular branch of the facial nerve was the most common donor site complication (1.7%). Dehiscence and infection were presented in only 1.0% and 0.2%, respectively. From a cosmetic point of view, the most common complication was the presence of dog-ear deformity at the donor site.


This literature review found several limitations being the most important one the lack of comparisons between possible risk factors and donor site complications. Therefore, more clinical studies are needed to find any relationships between them. However, following the different specialties’ recommendations, we should expect more favorable outcomes. Although considered a low morbidity flap, adequate patient selection, planning, and postoperative care can contribute to reduce morbidity even more. 

Level of evidence: Not ratable

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Correspondence to Erik Hanson-Viana.

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The only patient shown in the study provided verbal and written consent before their inclusion in this study. Additional consent was obtained for the use of his images.

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Erik Hanson-Viana, Marco Aurelio Rendón-Medina, María de los Ángeles Mendoza-Vélez, Ricardo C. Pacheco-López, and Julio Palacios-Juárez declare no conflict of interest.

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Hanson-Viana, E., Rendón-Medina, M.A., Mendoza-Vélez, M. et al. Refinements of the submental island flap donor site: a literature review and comparison among surgical specialties. Eur J Plast Surg (2021).

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  • Submental island flap
  • Submental flap
  • Donor site morbidity
  • Head and neck reconstruction
  • Local flaps
  • Pedicle flaps