The submental island flap in head and neck cancer

Faisal, Muhammad; Adeel, Mohammad; Riaz, Shazia; Anwar, Abdullah; Rashid, Asma; Usman, Sadaf; Jamshed, Arif; Hussain, Raza

doi:10.4103/ams.ams_225_18

Cited by 27 publications

(19 citation statements)

References 22 publications

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“…However, it has been reported that the SIF is limited in width . Conversely, in our opinion, the subclavicular TBSA pedicled flap has demonstrated to overcome the disadvantages of a limited flap width in comparison to the supraclavicular flap, and in addition, it has shown many advantages that other pedicled cervical flaps, such as the submental flap and the infrahyoid flap, do not. First, the subclavicular flap has a longer pedicle and higher pivot point that allows it to reach the mid‐face without compulsive positioning and a secondary operation for pedicle division can be avoided.…”

Section: Discussionmentioning

confidence: 69%

“…Other important advantages are the low morbidity of the donor site associated with this flap and the easy accessibility of the clavicular region in head and neck surgery, where there might be efficiencies gained in having the donor site in the same region as the ablation, such as time and cost savings by a single surgical setup . Other advantages might include the potential for a sensate flap through the inclusion of the supraclavicular nerves, and possibly multiple separate skin paddles based on different TCA perforators …”

Section: Discussionmentioning

confidence: 99%

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Subclavicular flap: A valid reconstructive option among anterior chest flaps in oral cancer patients

Mannelli

Agostini

Arcuri

et al. 2019

Journal of Surgical Oncology

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Background: The subclavicular pedicled flap is based on the thoracic branch of the supraclavicular artery, and it represents a versatile reconstructive option for lowmiddle third face defects. Since its use in head and neck surgical oncology has not been popularized yet, we propose its application for oral cavity reconstruction after cancer resection by showing favorable results.Methods: Eighteen subclavicular pedicled flaps were used to treat intraoral defects after oral squamous-cell cancer resection between June 2015 and December 2018.Tumor dissection type, complications, donor and reconstructed area results, and functional and aesthetic outcomes were assessed. Results: No major complications were observed and all of the flaps survived. Adjuvant therapy was administered without delay when needed, and all of the patients had normal functional outcomes and good aesthetic results. Conclusions: The subclavicular flap is an excellent choice for the reconstruction of oral cavity defects. Selection of patients should exclude positive lower-third neck node and include appropriate informed consent for women due to the possibility of deformity of the breast. In our opinion, this flap has the potential for common application given its consistent anatomy and donor site advantages, including long pedicle, high pivot point, and relatively unlimited flap width. K E Y W O R D S oral cancer, pedicled flap, reconstruction, thoracic branch of supraclavicular artery 1 | INTRODUCTION Deformed appearance and impaired function in the oral cavity due to tumor resection necessitate appropriate and high-quality reconstructive tissue. Among multiple reconstructive options, microsurgical techniques might be time-consuming and costly, and the results are not always satisfactory, even though free flaps remain the first choice for vessel-depleted neck and osseous reconstruction, as well as for through-and-through defects. 1 Consequently, the adjacent pedicled local flaps (eg pectoralis major, submental island, and deltopectoral flaps) are excellent alternative reconstructive options due to their fair color and contour, even though they are usually bulky. In this setting, the chest region seems to be an ideal donor site, with abundant vessel networks that can guarantee a high reconstructive success rate 2-4 and where, depending on the skin paddle design, differing skin thicknesses are available. In many people, the skin is not hair-bearing and the color match is ideal for cervicofacial skin. Various flaps have been explored, 5 including muscle-sparing thoracoacromial artery perforator flaps, 6 propeller flaps, 7 and supraclavicular flaps, 8 but the short length of the pedicle, the long distance Meeting: This paper was presented as oral presentation at the 24th Congress of the European Association for Cranio Maxillo Facial Surgery, 18 to 21 September 2018, in Munich, Germany.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Subclavicular flap: A valid reconstructive option among anterior chest flaps in oral cancer patients

Mannelli

Agostini

Arcuri

et al. 2019

Journal of Surgical Oncology

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“…Several studies have addressed the oncological safety of the SIF in head and neck reconstruction. However, the majority of those studies including our previous study have small sample sizes , and given the many factors that contribute to locoregional failure it is difficult for any of them, in our opinion, to cover and compare all these variables 26‐30 …”

Section: Discussionmentioning

confidence: 94%

“…However, the majority of those studies including our previous study have small sample sizes, and given the many factors that contribute to locoregional failure it is difficult for any of them, in our opinion, to cover and compare all these variables. [26][27][28][29][30] Tumor recurrence reported in literature, following oral cavity reconstruction using the SIF, ranges between 15.5% and 44.4%. 26,27 This wide range can be explained by the differences in sample size, patient selection, follow-up duration, and the variables looked at.…”

Section: Discussionmentioning

confidence: 99%

The contralateral based submental island flap for reconstruction of tongue and floor of mouth defects: Reliability and oncological outcome

et al. 2020

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Background Submental artery island flap (SIF) is a viable alternative to free flaps for selected oral‐cavity defects, however, concerns about its oncologic safety still exists. A novel harvesting technique and its outcome is described in here. Methods This is a prospective study for patients with lateralized oral tongue and/or floor of mouth (FOM) cancers who undergone reconstruction using pedicled SIF based on contralateral submental vessels (CSIF) following resection. Results Forty‐one patients were included. Twenty‐four patients had T2, 13 had T3, and 4 had T1 tumors. The largest flap skin paddle was 15 × 9 cm. One patient sustained complete and five sustained partial flap loss. Three patients developed tongue tethering. Median follow‐up was 13.6 months. Locoregional recurrence occurred in 11 patients (26.8%); 6 oral‐cavity recurrences (14.6%), 6 ipsilateral, and 1 contralateral neck recurrences (2.4%). Conclusion CSIF is a reliable flap that addresses the oncologic controversy and overcomes the disadvantages of ipsilateral flap.

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“…Since it was introduced by Martin et al, in 97 1993, it gained great popularity in reconstructing small to medium-sized orofacial defects [4]. Although this flap has several advantages, including an excellent skin color match and a wide arc of rotation, its oncological safety still of great concern [5]. This controversy comes from the fact that the submental vessels arise from the facial vessels at the level I group of the neck lymph nodes, the first-echelon lymphatic drainage basin for oral cavity carcinomas.…”

Section: Introductionmentioning

confidence: 99%

Safety Profile, Pros and Cons of the Submental Flap in Reconstruction of the Orofacial Defects after Malignant Tumor Resection

Osman

2021

The Egyptian Journal of Plastic and Reconstructive Surgery

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Objective: The main aim of this paper is to assess the safety profile and usefulness of the submental flap as a reconstructive tool for reconstructing orofacial defects after malignant tumor resection.Methods: A total sample of 23 patients suffering from oral cavity cancers during two years were included. All patients underwent surgical excision of the primary tumor and neck dissection with immediate reconstruction of the resultant defect using the submental flap.Results: Among patients included in the study sample, there were 15 males and 8 females. They were in the age group of 39 to 67 years old. Chin (1) buccal mucosa (5), alveolar margin (4), and tongue (13) were the primary tumor sites. After the operation, the evaluation of functions, swallowing, speaking, and jaw movements were all good in all patients. Advantages include long rotation arc, short operative time, short hospital stay, and excellent healing of the donner site. Disadvantages include the persistence of hair in male patients and recurrences in 5 patients. Conclusion:The study concluded that one of the best instruments for reconstructing orofacial tissue is the submental flap. It is easily harvested, valid, and locally available flap. However, it is necessary to use the submental flap with adequate care in patients with a positive neck.

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The submental island flap in head and neck cancer

Cited by 27 publications

References 22 publications

Subclavicular flap: A valid reconstructive option among anterior chest flaps in oral cancer patients

Subclavicular flap: A valid reconstructive option among anterior chest flaps in oral cancer patients

The contralateral based submental island flap for reconstruction of tongue and floor of mouth defects: Reliability and oncological outcome

Safety Profile, Pros and Cons of the Submental Flap in Reconstruction of the Orofacial Defects after Malignant Tumor Resection

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