Submental flap reconstruction for medium sized tongue defects: technique and surgical outcome-a retrospective study

Abstract

Background: Defects of the tongue has the major effect on speech and swallowing. Free flaps serve as an ideal choice for reconstruction but in developing countries, local flaps serve as an alternative in decreasing the morbidity and improving functional outcome with easy reproducibility by majority of head and neck surgeons. Surgical outcomes associated with submental flaps (SMF) used in the reconstruction of medium-sized defects of the tongue was evaluated as well a novel modification of the technique to safeguard the feeding vessel was presented.Methods: A total of 40 patients with tongue cancer who underwent SMF reconstruction from 2014 to 2017 with minimum 2 year follow up were retrospectively studied. The patient characteristics, tumor stage, nodal status, intraoperative findings, postoperative complications, locoregional recurrence, cosmetic satisfaction and functional outcomes were noted.Results: Out of 40 patients, 27 had pT2, 7 had pT3 and 6 patients had pT4 disease while 6 patients had pN1 and 2 patients had pN2 disease. Total flap necrosis, marginal skin paddle necrosis and total skin paddle loss were observed in 0, 5 and 1 patient(s), respectively. Venous congestion of the flap was the most common complication seen while no orocutaneous fistula or marginal mandibular palsy were seen. Five patients had locoregional recurrence and two patients had distant metastases. Functional and cosmetic outcome was excellent in most of patients.Conclusions: The SMF is a reliable and convenient technique that can serve as an alternative to free flaps in the reconstruction of medium-sized defects of the tongue.