Submental Island Flap: A Technical Update

Abstract

Objectives: In recent years, the submental island flap has demonstrated decreased cost and morbidity as compared with free tissue transfer and has been widely applied to a range of head and neck defects. Several studies, however, continue to report a high rate of submental flap complications including partial necrosis and venous congestion. The object of this report is to describe a technical modification to the submental flap harvest which increases efficiency and reliability. Methods: Single institutional case series with chart review. The essential technical details and technique modifications of the submental flap harvest are described, and a case example is discussed. Results: Between January 2018 through January 2019, 24 submental island flaps were performed. All flaps included the mylohyoid muscle which was delineated with manual blunt dissection. Reconstructive indications included oral cavity and oropharyngeal wounds as well as facial cutaneous and lateral skullbase defects. There were no flap-related complications. Conclusions: Manual blunt dissection of the mylohyoid muscle and its inclusion in the submental island flap increases efficiency and reliability.

Vertical Submental Island Flap for Head and Neck Reconstruction

“…Furthermore, although several modifications have been developed of the submental island, none of the modifications has included a vertical component. [7][8][9][10][11][12] This vertically oriented flap provides for straight line linear closure in the midline of the neck, which in the present case, aided in reestablishing the cervicomental angle, normalizing the cervical contour, and improving donor site cosmesis. Moreover, given our patient's previous ablative and reconstructive procedures, the vertical orientation allowed for direct access to nearly the full length of the pectoralis major muscle flap, which, after debulking and recontouring, further facilitated cervical recontouring.…”

“…Furthermore, several modifications of this procedure have been developed, although none have included a vertical island flap. [7][8][9][10][11][12] We describe a novel variation using a vertically based submental island flap for maxillary reconstruction in a patient with significant coronary and peripheral arterial disease that prohibited microvascular reconstruction. The diamond-shaped flap was inset along the long axis of the maxillary arch with resulting straight line linear closure in the neck and optimized esthetics of the donor site.…”

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

“…whereby the ipsilateral anterior belly of the digastric muscle and underlying mylohyoid muscle are included within the dissection to protect the pedicle and associated perforators. 21,22 Preoperatively, the arterial doppler signal of the submental pedicle is always identified prior to proceeding with the submental flap. In the setting of prior contralateral neck dissection, this is an especially critical step to confirm the presence of the flap perforator, which conceivably could be damaged during prior level IA dissection.…”

Regional pedicled flap salvage options for large head and neck defects: The old, the new, and the forgotten

“…A novel harvest technique was published in 2007 by Patel et al 46 and expanded on by Zenga et al in 2019, 47 emphasizing the incorporation of the ipsilateral mylohyoid muscle and anterior belly of the digastric in the flap pedicle. This simple, yet effective modification further protects the distal submental artery and dominant cutaneous perforators leading to greater flap viability and decreased flap tip necrosis.…”