Systematic review of submental artery island flap versus free flap in head and neck reconstruction

Mooney, Sean; Sukato, Daniel C.; Azoulay, Ofer; Rosenfeld, Richard M.

doi:10.1016/j.amjoto.2021.103142

Cited by 16 publications

(10 citation statements)

References 37 publications

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“…Several systematic reviews reported significantly decreased operating time and hospitalization length, with similar long-term results for submental flap reconstructive surgeries compared with free flap reconstruction techniques. However, the size of the reconstructed defect was smaller and the incidence of partial flap failure was higher in submental flap groups ( 31 , 32 ). In the present case, in order to compensate for the limitations related to the size of the defect, it was chosen to combine two reconstructive techniques, thus increasing the supply of transferred tissue, which allowed for an appropriate reconstruction of the entire defect, with no postoperative complications.…”

Section: Discussionmentioning

confidence: 89%

A combination of two regional flaps for the complex reconstruction after head and neck cancer surgery as an alternative approach during the COVID‑19 pandemic: A case report

Căruntu¹,

Moraru²,

Comăneanu

et al. 2022

Exp Ther Med

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Since the COVID-19 pandemic outbreak, the medical systems were challenged by continuously increasing numbers of infections and faced critical issues when trying to find solutions for patients suffering from other diseases, including patients with head and neck cancers. Complex surgeries were delayed due to an acute deficit of specialized intensive care medical staff and equipment, which were redirected towards COVID-19 hospitalized cases, with irreversible consequences for the patients. In the present study, the case of locally advanced head and neck cancer was presented, which was treated radically during the heaviest wave of the COVID-19 pandemic in Romania using an alternative approach for immediate defect reconstruction. The case of locally advanced buccal carcinoma (staged T4aN0Mx) was reported, where radical tumor excision was followed by immediate reconstruction using a combination of two regional flaps, temporal and submental, in order to provide timely and optimal medical care. In the difficult context of the COVID-19 pandemic, the standard reconstructive technique, which is the free vascularized tissue transfer, could not be performed for this patient, due to the acute deficit of anesthetists and associated medical staff, as well as the lack of free beds in intensive care units. Combinations of local and regional flaps, such as temporal muscle flap and submental flap, are simple and accessible surgical techniques that require reduced surgical time, minimal equipment, and basic surgical training, advantages that become crucial in historically challenging times, such as a global pandemic. Individual cases, like elderly patients or patients with severe comorbidities, should be considered for these types of reconstructive techniques: simple solutions, single or in combination, which may be an improved therapeutic option for these patients.

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Section: Discussionmentioning

confidence: 89%

A combination of two regional flaps for the complex reconstruction after head and neck cancer surgery as an alternative approach during the COVID‑19 pandemic: A case report

Căruntu¹,

Moraru²,

Comăneanu

et al. 2022

Exp Ther Med

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“…A complete comparison summary of harms reporting for the dyad with “high” overlap can be found in Table 5. In the first SR by Mooney et al, the authors reported recipient site dehiscence and infection which were not reported by Jørgensenn et al 33,34 In the second SR, Jørgensenn et al reported debulking revisions and length of hospital stay 34 . The remaining harms were included in both SRs 33,34 .…”

Section: Resultsmentioning

confidence: 99%

“…34 The remaining harms were included in both SRs. 33,34 The most cited reference was cited in 5 of our included SRs. Of the unique primary studies, 644 were cited once, 151 were cited 2 to 4 times, and 1 primary study was cited in 5 SRs across our sample.…”

Section: Ccamentioning

confidence: 99%

Harms Reporting in Systematic Reviews of the Microvascular Free Flap in Head and Neck Reconstruction

Wilson

Ernst

Wise

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveTo evaluate harms reporting in systematic reviews (SRs) of microvascular free flap (MFF) in head and neck reconstruction.Data SourcesThis cross‐sectional analysis included searches from the following major databases from 2012 to June 1, 2022: MEDLINE (Pubmed and Ovid), Embase, Epistemonikos, and the Cochrane Database of Systematic Reviews.Review MethodsIn a masked duplicate manner, screening was performed using Rayyan, and data were extracted using a pilot‐tested Google form. A MeaSurement Tool to Assess systematic Reviews‐2 (AMSTAR‐2) was used to appraise the methodological quality of reviews and the corrected covered area was calculated to detect primary study overlap across all reviews. Reviews were then grouped in pairs of 2, called dyads, and the corrected covered area was calculated again for each individual dyad. Dyads with high overlap (≥50%) were further investigated for the accuracy of harms reporting.ResultsOur initial search yielded 268 records, with 50 SRs meeting the inclusion criteria. A total of 46 (92%) of the included reviews demonstrated 50% or more adherence to the items assessed in our harms checklist. Our corrected covered area tool revealed 0.6% primary study overlap across all reviews, and 1 dyad with high overlap (≥50%). No statistically significant relationship was observed between the completeness of harms reporting and reviews listing harms as a primary outcome, reviews reporting adherence to Preferred Reporting Items of Systematic Reviews and Meta‐Analyses, or a review's AMSTAR rating.ConclusionThis study identifies how harms reporting in SRs of MFF reconstruction of the head and neck can be improved and provides suggestions with the potential to mitigate the paucity in current literature.

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“…FSAIF requires a shorter operation time and hospital stay, and has comparable perioperative outcomes, to free tissue transfer. In addition, flap use was associated with significantly shorter operation times and hospital stays, satisfactory aesthetic outcomes, no increase in the local tumor recurrence rate, fewer perioperative complications, and prolonged survival [ 28 – 31 ]. However, the use of FSAIF did not affect locoregional recurrence in clinically node-negative OTSCC patients [ 20 ], although the harvested flap area was significantly smaller.…”

Section: Discussionmentioning

confidence: 99%

Facial-submental island flap for reconstruction of hemitongue defects in young, middle-aged and elderly patients with early and middle stage oral tongue squamous cell carcinoma

et al. 2022

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Background This study evaluated the outcomes of facial-submental artery island flap (FSAIF) for reconstruction of the hemitongue following cancer ablation in patients with early and middle-stage oral tongue squamous cell carcinoma (OTSCC). Methods In total, 122 patients with early and middle-stage OTSCC were divided into young, middle-aged, and elderly groups. The Adult Comorbidity Evaluation-27 (ACE-27) index was used to determine the presence of comorbidities. The patients underwent surgical treatment with hemiglossectomy, neck dissection, and hemitongue reconstruction using FSAIF. In addition, stage I (n = 15) and II (n = 69) patients underwent ipsilateral selective neck dissection, whereas those with stage III (n = 38) underwent radical neck dissection. Six patients with T3N1 disease also underwent cobalt-60 adjuvant radiotherapy. Results Young and elderly patients exhibited significant differences in comorbidities, as assessed by the ACE-27 (p < .05). The skin paddles in the young, middle-aged, and elderly patients were 3 × 9 to 4 × 12 cm, 3 × 11 to 4 × 12, and 3 × 10 to 5 × 13 cm in size, respectively. FSAIF failure occurred in four patients (success rate: 96.7%). No significant differences were observed in the skin paddle of the flap or rate of flap failure among the age groups (p > .05). Clavien-Dindo grades I, II, IIIa, IIIb, Iva, and IVb were assigned to 7.1, 36.1, 38.5, 9.8, 4.1, and 4.1% of the patients, respectively, with significant differences seen between the young and elderly patients (p < .05). In total, 52.5% of patients could eat normally, whereas 32.8% required a soft diet. Furthermore, 53.3 and 33.6% of patients achieved normal and intelligible speech, respectively. The aesthetic results were rated as excellent and good in 32.8 and 58.2% of patients, respectively. In total, 68.0% of the patients were alive and exhibited no evidence of disease, while 19.7% were alive with active disease. In addition, 12.3% of patients with stage III OTSCC died due to local recurrence or distant metastases. No differences in swallowing, speech, aesthetic, or survival outcomes were observed among the groups. Conclusions FSAIF is a simple, safe, and reliable method for reconstructing hemitongue defects following cancer ablation in young, middle-aged, and elderly patients with early and middle-stage OTSCC.

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Systematic review of submental artery island flap versus free flap in head and neck reconstruction

Cited by 16 publications

References 37 publications

A combination of two regional flaps for the complex reconstruction after head and neck cancer surgery as an alternative approach during the COVID‑19 pandemic: A case report

A combination of two regional flaps for the complex reconstruction after head and neck cancer surgery as an alternative approach during the COVID‑19 pandemic: A case report

Harms Reporting in Systematic Reviews of the Microvascular Free Flap in Head and Neck Reconstruction

Facial-submental island flap for reconstruction of hemitongue defects in young, middle-aged and elderly patients with early and middle stage oral tongue squamous cell carcinoma

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