Clinical outcome and oncological safety of submental flap for reconstruction in head and neck cancer patients

Abstract

Background: Submental flap is an axial pattern, myo-cutaneous flap based on submental artery (branch of facial artery). We have used this novel flap for reconstruction of the intra-oral, as well of the lower and mid face defects created after resection of certain intra-oral malignancies. Materials and Methods: This study included 15 patients and done over a period of 3 years. Cases were operated by a team of surgical oncologists using the same technique and under 2.5 x magnifications (loupe). Any nodes in the region were carefully dissected and sent for frozen section for intra-operative verification of presence or absence of microscopic tumor deposits. Evaluation had been done based on the clinical and pathological staging, nodal status as well as the patient outcome. Results: Out of the 15 patients who underwent reconstruction with submental flap, one patient developed total flap loss, whereas one patient had partial flap necrosis. The remaining 13 patients showed decent clinical outcome and the flap uptake was good. In the follow up period of 2 years, two patients developed regional recurrence (none in the flap donor or recipient sites) and 2 developed distant metastasis. Conclusion: Submental flap is an excellent flap for reconstruction of small to medium size defects for intra-oral as well as lower and mid face. It is useful in medically compromised conditions, old age or low socio-economic status of the patient as these factors preclude the use of a free flap. It is oncologically safe for reconstruction and in the absence of clinical or radiological evidence of nodal disease in sub-mental region and may be considered for reconstruction in N0 as well as N1 patients.