Reverse facial artery flap from the submental region

Reverse submandibular gland flap: An alternative for reconstruction of medium-sized oral defects

Despite the development of microsurgery, local flaps still play an essential role in the reconstruction of head and neck defects. The submandibular gland flap (SMGF) has proven to be a reliable method for repairing medium-sized defects. It requires a shorter duration of general anesthesia and has fewer donor site complications compared to the free flap. However, the restricted vascular pedicle length limits its application. Retrograde flow is one solution. The authors describe a novel technique of using reverse submandibular gland flap (RSMGF) for the reconstruction of oral cavity defects. Additional vascular pedicle length was obtained by ligating the proximal end and dissecting the distal end of the facial vessels, thus extending its application range. The RSMGF is technically feasible and suitable for repairing medium-sized defects of the oral cavity (cT2 stage tumor) like buccal mucosa, especially for the elderly in poor general condition, for whom free flaps are not applicable.

Extended Pedicled Perforator Plus Submental Flap for Large Cheek Defect Reconstruction

The submental flap is an alternative repair technique in the maxillo-facial region when microsurgical reconstruction is not required or is difficult to apply. The purpose of this study was to illustrate the benefits of restoring the cheeks with an extended pedicled submental flap.

Method

Eight patients aged 58 to 81 years with cheek cancer presented to the surgery department at the Benha University Hospital in Egypt, from May 2019 to October 2021 for the removal of their tumors and reconstruction of the resulting defects, using the extended submental perforator plus pedicled artery flap.

Results

The average blood loss was 250 cm³ (range: 50-400 cm³). The average operation took 3 hours to complete, including excision and rebuilding (a range of 2.5 to 3.5 hours). The length of the postoperative hospital stay was 2 to 4 days. Fortunately, there was no complete flap loss; nonetheless, distal flap necrosis in one case left a raw area, which was allowed to heal naturally, and hemorrhages in two cases were conservatively handled.

Conclusions

For the reconstruction of cheek abnormalities, the submental flap is a viable alternative, particularly in older patients or patients whose overall health has declined and who need less severe therapies and quicker surgery. The submental flap, which conceals the donor site, provides a dependable supply of skin for facial resurfacing with excellent color, shape, and texture matching. The flap is quick, and easy to raise.

Unique Characteristics and Applications of Reverse Superior Labial Artery Island Flaps: A Case Series

Background: The reverse superior labial artery (rSLA) island flap can be used to reconstruct the cheek, ala, columella and vestibule of the nose when other techniques appear insufficient or impractical. The aim of this case series was to present applications of rSLA pedicle flaps in the post-ablative oncologic reconstruction of the face. Patients and Methods: Using a retrospective case-series study design, the investigators enrolled a cohort of patients undergoing procedures involving rSLA flaps treated at a Polish Otolaryngology Department for facial reconstruction after tumour excision. The main outcomes were functional and aesthetic aspects. Descriptive statistics were computed as appropriate. Results and Conclusions: The use of rSLA flaps allows surgeons to obtain a large skin island with only minimal cosmetic and functional alterations. In all of the cases in this series, the use of this pedicle flap resulted in both optimal healing and satisfactory cosmetic and functional outcomes.

Colgajo submentoniano en la reconstrucción de cabeza y cuello

Introducción. Los colgajos del territorio de la arteria submentoniana pueden ser utilizados como un colgajo cutáneo, musculofacial y osteocutáneo, realizando cierres primarios del defecto del sitio donante, sin generar defectos funcionales ni estéticos mayores. Métodos. Describir la experiencia de nuestro equipo quirúrgico, las complicaciones relacionadas con el uso del colgajo y los resultados oncológicos, así como los desenlaces tardíos durante el seguimiento de los pacientes incluidos en el estudio. Resultados. Se incluyeron veintiún pacientes, con una edad media de 66 años (rango 52 - 86), con patología oncológica de lengua, labio inferior, paladar blando, nariz, órbita y orofaringe. Todos los pacientes fueron sometidos a disección selectiva ipsilateral del cuello, tras la extracción del colgajo y en todos los casos se preservó el nervio mandibular marginal. Se registraron complicaciones como la necrosis parcial. La estancia hospitalaria media fue de 8 días. Conclusiones. El colgajo de la arteria submentoniana ha mostrado resultados favorables debido a su uso versátil, amplio arco de rotación, color y baja morbilidad del sitio donante. Se recomienda realizar estudios más robustos, que incluyan la experiencia de diversos especialistas en países que compartan las mismas limitaciones técnicas y características sociodemográficas.

Submental Island Flap After Prior Contralateral Neck Dissection: A Case Series and Technical Considerations

OBJECTIVES

The submental island flap is a dependable workhorse in head and neck reconstruction. However, the viability of this flap has not been established for oral cavity reconstruction when a contralateral neck dissection has already been performed in an earlier surgical setting. The aim of this study is to highlight technical considerations and outcomes of this approach with a small case series.

METHODS

Three cases of oral cavity reconstruction with a submental island flap elevated in the context of a prior contralateral neck dissection are presented.

RESULTS

In all cases, a doppler was used to identify the maintenance of the submental perforator in the neck opposite the previous neck dissection. In 2 cases, level IA was included within the dissection field of the previous neck dissection. Additionally, the old neck scar was included within the skin paddle of the submental island flap in 2 cases. In all cases, excellent healing of the flap was observed without partial or complete loss.

CONCLUSIONS

The submental island flap appears to be a reliable reconstruction when a previous contralateral neck dissection has been performed, even when level IA was included in the prior dissection.

Oncologic safety of submental island flap reconstruction in clinically node-negative oral cancer patients: a prospective comparative study

The purpose of this study was to evaluate the oncologic safety of submental island flap (SIF) reconstruction in clinically node-negative oral cancer patients. Forty-four clinically node-negative oral cancer patients with tumour size T1-T3 were divided into two groups. The Submental group consisted of 21 patients, who underwent submental island flap reconstruction whereas the control group consisted of 23 patients who underwent reconstruction with other locoregional or free flaps. The locoregional recurrence rate (LRR) and recurrence-free survival (RFS) in these two groups were assessed and compared. The follow-up period in the two groups ranged from six to 28 months, with a median follow-up period of 15 months and 21 months, respectively. Results showed that the LRR in the control and the submental group was 21.7% and 19%, respectively (p = 0.825). Kaplan-Meier curve showed that the difference in recurrence-free survival in the two groups was not statistically significant (p = 0.749). Multivariate and bivariate analyses did not establish any relationship between the predictive parameters and locoregional recurrence. Thus, the Submental island flap is a reliable and versatile locoregional flap for the reconstruction of post-resection defects in oral cancer. It has no predictive influence on locoregional recurrence in clinically node-negative oral cancer patients.

Submental Artery Island Flap in Oral Cavity Reconstruction. An Observational, Retrospective Two-centre Study

Introduction  The submental flap provides an alternative technique in orofacial reconstruction, especially in situations in which free flaps are not available, or the patients are unfit. Objective  To demonstrate the oncological safety and benefits of this flap in oral cavity reconstruction. Methods  A total of 14 patients with oral cavity cancers, who underwent submental flap reconstruction from January 2016 to January 2018, were included in the study. Results  There were 11 male and 3 female patients with a mean age of 66.7 ± 14 (Min: 52/Max: 91) years old. The most common primary tumor site was the mobile tongue in 12 (85.7%) patients. All of the patients underwent ipsilateral selective neck dissection after the flap was harvested. Flap partial necrosis was observed in one patient, and total necrosis in another one. The mean follow-up was of one year. Nonlocal or regional recurrences were observed. Conclusion  Submental island flap represents a good option in oral cavity reconstruction in a restricted setting or in patients considered not fit for free flap reconstruction. Preoperative selection of clinically neck node-negative patients is essential due to the potential risk of occult metastasis.

The Laterally Extended Paramedian Forehead Flap for Nasal Reconstruction: The Delay Technique Revisited

Background:

Problems with poor circulation often occur when a large defect or a distant region, such as the apex of the nose, is covered with a paramedian forehead flap. Delay technique increases the safety of reconstruction procedures, but it has been used less frequently because a 2-stage surgery is necessary, and various other flaps and techniques have been developed.

Method:

We performed the delay technique of paramedian forehead flap at the same time as tumor resection. For the flap, a narrow pedicle of about 1-cm was prepared on the supratrochlear artery and vein, and the incision was extended toward the lateral side conforming to the defect morphology, and a paramedian forehead flap with a design consistent with the esthetic unit containing the defect was prepared. The region below the flap was dissected to create the flap bipedicle, and surgery was completed.

Result:

This procedure was used in 4 patients with malignant tumor of the external nose, and the flap survived perfectly in all patients. The postoperative esthetic outcome was also found to be good.

Conclusions:

This procedure does not increase the frequency of surgery, circulation in the flap is maintained, the flap pedicle on the supratrochlear artery can be made narrow, and flap thinning can be performed from the beginning. Coverage of an extensive defect is possible because a large flap can be excised, and satisfactory esthetic appearance can be obtained by matching with the esthetic unit. The delay technique for various flaps (not limited to forehead flap alone) should be considered an effective technique for the current treatment of malignant tumors.

[Submental island flap: a review of the literature]

The submental island flap is a precious tool in reconstructive surgery. It was described by Martin in 1993, inspired by platysma flaps. In our days, we can find many reliable techniques for this procedure. We reviewed the main studies of the literature that described a total of 528 patients. The rate of partial necrosis was 5.1%, complete necrosis 1.7%, and reversible lesions of the marginal mandibular branch of the facial nerve 1.1%. His versatility makes this flap appropriate for the reconstruction of every part of the face: cheeks, nose, forehead, moustache, beard, and hairs. It can also be used de-epidermised with very good results, for the reconstruction of the buccal cavity, the tongue, the roof of the mouth, the larynx, and the proximal part of the esophagus. The SMAP (Submentalis Artery Perforator flap) is an alternative flap that provides even better cosmetic results. The development of indocyanine green and infrared cameras will allow in a close future to decrease the postoperative complications.

Reverse facial artery flap to reconstruct the medium-sized defects in the middle facial region following cancer ablation

This retrospective clinical study assessed the reliability of the reverse facial artery flap to reconstruct the medium-sized defects in the middle facial region following cancer ablation.Fifteen medium-sized defects were repaired with reversed facial artery flap following cancer surgery. The ages of the patients ranged from 2 to 69 years; 9 were male and 6 were female. The primary lesions included palate (5 cases), maxillary gingival (6 cases), cheek or buccal mucosa (3 case), and upper lip (1 case). The size of the skin paddle varied from 4.0 cm × 6.0 cm to 5.0 cm × 10.0 cm. Direct closure was achieved at all donor sites. Fourteen of the 15 flaps survived. No donor-site problems occurred. Two patients appeared to have temporary injury of facial nerve after operation. The follow-up period ranged from 8 to 36 months; 1 patient died as a result of local recurrence and 1 patient developed cervical recurrence.Consequently, it has been demonstrated that the reversed facial artery flap had reliable blood supply and can reliably and conveniently be used for reconstruction of the medium-sized defects, especially in the middle third of oral and maxillofacial region.

Combined flaps for reconstructing wide-range facial defects

BACKGROUND

This report aims to describe the technique of using combined flaps for reconstruction of wide-range facial defects.

METHODS

Two or more flaps were combined to repair wide-range facial wounds, complying with the principle of facial aesthetic subunits to maintain the inherent structural characteristics of the face, to design incision lines conforming to the natural facial contour lines (e.g., nasolabial fold, sulcus alaris, nasomaxillary suture, palpebral margin, vermilion border, hairline) or wrinkles, and to leave hidden incision lines if possible. There were 18 cases with excessively large facial defects requiring the use of a graft with local flaps.

RESULTS

From April 1996 to May 2008, 124 patients had their wide-range facial defects repaired by combined flaps. The size of the defects ranged in size from 2.5 × 4 to 9 × 10 cm. The healing for all the patients was uneventful, and the flap survived completely without complications. After an average of 6 months (range, 1-48 months), 87 of the patients were available for follow-up evaluation. There was no recurrence of tumor. The repaired tissues were well matched with surrounding tissue in color, texture, and contour. Incision lines were sheltered, and there were no anatomic deformities of the eyelid, upper lip, or nasal ala.

CONCLUSIONS

Based on the facial aesthetic subregion principle, combined flaps were used to reconstruct wide-range facial defects effectively, obtaining good color, contour, and texture match with the surrounding skin. All in all, the cosmetic results were satisfactory.