A comparative study between submandibular-facial artery island flaps (including perforator flap) and submental artery perforator flap: A novel flap in oral cavity reconstruction

Submental Artery Perforator Flap Drained Solely With the Vena Comitans of Facial Artery

BACKGROUND

The submental artery perforator flap (SMAPF) is an alternative to reconstruct oral and maxillofacial defects secondary to oral cancers. However, vascular anomalies or surgical damage often lead to vascular crises or harvest failure. Our clinical findings suggest that the vena comitans of the facial artery (cFA) very commonly exist. This study aimed to investigate the reliability of the cFA as a sole venous reflux route for the SMAPF.

METHOD

The patients were from the Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Jilin University. All patients were treated for oral cancer between January 2016 and September 2022. Seventeen SMAPFs were successfully raised to reconstruct the postoperative defects, of which 7 had cFA as the sole reflux route.

RESULTS

The size of the flaps varied from 4.0×3.0 cm to 12.0×3.0 cm. All flaps survived. Patients were followed from 1 month to 5 years. Satisfactory restoration of contour and functional outcomes were achieved at the recipient sites. The scars were well camouflaged in the submental region. No local or regional recurrence was detected during follow-up. Patients had an overall 2-year survival rate of 100% with no suspected flaps-related recurrence.

CONCLUSIONS

The cFA as the sole venous reflux route for SMAPF is reliable for flap harvesting and is applicable for immediate defect reconstruction secondary to cancer resection.

Tongue Reconstruction After Hemiglossectomy Due to Cancer by Submental Flap: A Case Series

We report three clinical cases using a submental flap to reconstruct the half-tongue defects after tongue cancer surgery at Hue Central Hospital (Hue city, Vietnam). The size of the flap ranged 30–60mm. The time to take flap ranged 50–60 minutes. All three patients did not have liquid accumulation, wound infection and bleeding after surgery; the flap survived well. All patients were taken the nasogastric tube out after ten days and discharged after two weeks. Postoperative functional (speech, swallowing) and tongue aesthetic assessments (symmetry) were good. These cases highlight that the submental flap is a choice for patients with flaws in the tongue. It ensures both functional and aesthetic for the regenerative tongue and donor site.

Resurgence of regional flaps for head and neck reconstruction

PURPOSE OF REVIEW

The strain on healthcare resources in light of the COVID-19 pandemic has forced many head and neck surgeons to explore reconstructive options that may decrease length of stay. Here, we review three common and versatile regional flaps used in head and neck reconstruction that are comparable alternatives to free tissue transfer.

RECENT FINDINGS

Initial anatomic descriptions of the facial artery musculocutaneous (FAMM) flap, the supraclavicular artery island flap and the submental artery island flap were published decades ago. Since then, many have proposed modifications to these descriptions to improve technical ease and patient outcomes. Benefits of regional flaps include ease of harvest, comparable outcomes to free tissue microvascular flaps, shorter operative time and hospital length of stay. Drawbacks to regional flaps include limitations to size and reach, partial necrosis, wound dehiscence and surgeon experience. The integrity of the vascular pedicle is also contingent upon vessel preservation during the cancer ablation.

SUMMARY

Although a resurgence of regional flaps began well before the COVID-19 pandemic, many institutions began looking for alternatives to free flap reconstruction to conserve healthcare resources and minimize patient hospitalization time in the past year. There has been a revival of regional flaps such as the FAMM, supraclavicular and submental flaps that are valuable reconstructive options for many defects of the head and neck.

Analysis of hospitalization costs and length of stay for oral cancer patients undergoing surgery: Evidence from Hunan, China

OBJECTIVE

To provide information about hospitalization costs and length of stay (LOS) for inpatients undergoing oral cancer (OC) surgery, and to investigate the association of hospitalization costs and LOS with demographics, tumor subsite, surgery-related and hospital characteristics.

METHODS

Data extracted from Chinese National Health Statistics Network Reporting System database in Hunan, China during 2017-2019 were analyzed using quantile regression models.

RESULTS

A total of 6,420 OC patients undergoing surgery were identified. After controlling potential compounding variables, the median hospitalization cost was significantly higher in male than in female patientsby $515.70 at the median (p < 0.001). Patients aged over 60 hadsignificantly less costs by $294.85 at the meanthan did those below 60, while no differenceof LOS existed across age. OC patients with neck dissection had significantly higher costs by $1,983.33 at the median than those without (P < 0.001). Regional flaps were the most economical, with lower costs than free flaps by $3,084 (P < 0.001) and the pectoralis major myocutaneous flap (PMMF) by $549.45 (P < 0.001) at the median.

CONCLUSION

Male is a significant driver of hospitalization costs and LOS for OC, and age over 60 is associated with lower costs, but not with LOS. Mouth primary site is associated with the highest costs and LOS, while lip primary site the lowest. Absence of neck dissection in early-stage OC can significantly reduce costs and LOS, but its oncological validity needs more evidence. Regional flaps are less expensive than free flaps and the PMMF for oral reconstruction, and are recommended in select patients.