The submental flap for head and neck reconstruction: Comparison of outcomes to the radial forearm free flap

Abstract

Objectives To compare intraoperative, postoperative, functional, and oncologic outcomes of the submental island pedicled flap (SIPF) to the radial forearm free flap (RFFF). Study Design Retrospective review; comparison with statistical analysis. Methods A retrospective review was performed on patients at two tertiary care academic hospitals by a single surgeon. Consecutive patients who underwent cancer resection and reconstruction with SIPF or RFFF between 2004 and 2016 were included. Cancer staging, surgical procedure, hospital stay, complications, and functional and oncologic results were extracted. Results The study included 146 patients (57 SIPF; 89 RFFF). The most prevalent primary site was oral cavity, with a minority in the oropharynx, paranasal sinuses, or external face. Mean area of the SIPF was smaller at 28 cm2 compared to 48 cm2 for the RFFF. Operative time for SIPF was shorter at 6.5 hours compared to 9 hours for RFFF. Hospital stay was 8.0 days for SIPF patients and 10.0 days for RFFF patients. Multivariate analysis confirmed these differences were significant. Functional outcomes of speech quality and gastrostomy feeding tube dependence were similar between the SIPF and RFFF groups. There was no difference in local recurrence rate for SIPF (16%) and RFFF (19%), and there was no difference in overall recurrence. Kaplan‐Meier curves showed no difference in recurrence between both groups, and multivariate logistic regression demonstrated no association between SIPF and local recurrence. Conclusion Operative time and hospital stay are both significantly reduced with the SIPF. Functional and oncologic results are similar with no contraindication to the SIPF. The SIPF is a good first‐line choice for head and neck reconstruction. Level of Evidence 3 Laryngoscope, 130:S1–S10, 2020

Transoral robotic salvage oropharyngectomy with submental artery island flap reconstruction

“…The SAIF has been shown to compare favorably with free flaps in terms of operative time and LOS 1,5 . The SAIF is equivalent to free flaps in terms of rate of flap failure and revision as well 5 .…”

“…While free tissue transfer remains the workhorse for reconstructing large defects of the head and neck, the SAIF has demonstrated value for a variety of reconstructive challenges. In comparison with free flaps, the SAIF offers lower procedural time and hospital length of stay (LOS) 1,5 . Harvest is technically straightforward, and donor‐site morbidity is minimal.…”

“…The submental artery island flap (SAIF) is a wellestablished reconstructive option for defects of the head and neck; commonly utilized for the oral cavity, temporal bone, parotid, or skin. [1][2][3][4] While free tissue transfer remains the workhorse for reconstructing large defects of the head and neck, the SAIF has demonstrated value for a variety of reconstructive challenges. In comparison with free flaps, the SAIF offers lower procedural time and hospital length of stay (LOS).…”

“…In comparison with free flaps, the SAIF offers lower procedural time and hospital length of stay (LOS). 1,5 Harvest is technically straightforward, and donor-site morbidity is minimal.…”

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

“…In addition, this study included patients with primary cancers in salivary glands, paranasal sinuses, skin, and oropharynx which might have a less aggressive nature and recurrence potential compared to oral cavity cancers. 31 Chang, Asarkar, and Nathan published a comprehensive review in an attempt to resolve the controversy surrounding the use of the SIF in oral cavity cancer and concluded that it is oncologically safe to use in N0 neck. However, regarding its use in the presence of positive neck nodes, there were limited quality data supporting this with reasonable oncologic safety that was at risk of selection bias.…”