Reconstruction of an inferior orbital rim and cheek defect with a pedicled osteomyocutaneous submental flap

Felasi, Mohammad Al; Bissada, Éric; Ayad, Tareck

doi:10.1002/hed.24146

Cited by 6 publications

(7 citation statements)

References 14 publications

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“…The SIF can also be employed in elderly patients to avoid risks associated with free-flap reconstruction, as emphasized by our second and third cases on an 88-year-old female and 75-year-old male. From an operative standpoint, the SIF provides an aesthetically hidden donor site, excellent facial color match, wide axis of rotation and large area of well-vascularized soft tissue [ 1 , 5 ]. Furthermore, the flap is thin and does not include bulky muscle tissue as is the case in other regional flaps [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

“…These features of the SIF obviate the need for multiple pedicle divisions and sacrifice of functional muscle [ 1 ]. An osteocutaneous flap can also be harvested using the inferior mandible as a source of vascularized bone as demonstrated in our report [ 5 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…A unique feature of the SIF is the ability to harvest the flap with the inferior portion of the mandible as a source of vascularized bone [4,5]. This feature derives from the submental branch of the facial artery, which also gives off several unnamed penetrating vessels that supply the inferior mandibular component [4].…”

Section: Introductionmentioning

confidence: 99%

“…A very recent study describes a series of eight patients who successfully underwent reconstruction of defects involving the maxilla, orbital rim or short zygomatic arch component with a composite SIF [8]. Another group has also previously reported on the osteomyocutaneous SIF for reconstruction of the inferior orbital rim [5]. Overall, the applications of the composite SIF beyond lower facial structures are limited in the literature, especially in cases of complex facial defects.…”

Section: Introductionmentioning

confidence: 99%

“…The SIF has demonstrated excellent results for reconstruction of defects involving the oral cavity, oropharynx, hypopharynx and lower face [ 1 ]. The flexibility of the vascular pedicle allows the SIF to extend to regions beyond the lower facial structures [ 4 , 5 ]. However, the applications of SIFs in reconstruction of the upper face, especially with defects involving the facial skeleton remain extremely limited in the current literature.…”

Section: Introductionmentioning

confidence: 99%

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Composite submental flaps in facial reconstructive surgery involving the zygoma and orbit

Khan

Haupt

Rigby

et al. 2020

Journal of Otolaryngology - Head & Neck Surgery

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Background The submental island flap (SIF) is a reliable option for reconstructing defects in the facial region and offers several advantages when compared to free-flap alternatives. While the reconstructive applications of the SIF have been demonstrated in the lower face, there are limited reports on its utility as a composite flap for reconstructing defects of the upper facial skeleton. To our knowledge, we report the first cases of composite (osteocutaneous) SIFs used for reconstruction of complex facial defects involving the zygoma and lateral orbit respectively. Case presentations Three consecutive cases are presented. All were performed following resection of skin cancers with invasion of the upper facial skeleton. The first case was a 68-year-old male with a longstanding history of non-melanoma skin cancers who presented with a 7 cm recurrent basal cell carcinoma (BCC) with bicortical invasion of the left zygoma. The second case was an 88-year-old female with several squamous cell carcinomas (SCC), including a dominant 7.1 cm SCC on the right temple with orbital invasion. A third case was a 75-year-old immunosuppressed male with a 6.5 cm SCC of the right cheek with invasion of the orbit and zygoma following prior resection as well as high dose radiotherapy. The operative management of all cases involved harvesting the SIF on its vascular pedicle alongside the inferior portion of the mandible with rigid fixation to address the bony defects. The first case was robust throughout adjuvant radiotherapy with no flap complications after 2 year follow up. The second patient received adjuvant radiation therapy to an area that was previously radiated. Although the flap remained viable for a year, the patient experienced delayed soft tissue loss over the bony segment and eventual devitalization of the distal flap. The third case achieved a satisfactory result with no complications. Conclusions Our case series outlines a unique application of the composite (osteocutaneous) submental island flap (SIF) for reconstruction of complex facial defects involving the upper facial skeleton. The osteocutaneous SIF should be used with caution in patients receiving adjuvant radiotherapy who have a history of previous radiation to the same or overlapping field. Graphical abstract

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%