Modified Incision Design for Submental Flap: An Excellent Design Method for the Reconstruction of a Defect after Head and Neck Tumor Resection

Nan Guo,Xue-Xin Tan,Zhong-Fei Xu,Fa-Yu Liu,Jawad Safdar,Jun-Lin Li,Chang-Fu Sun,Zhen-Ning Li,Shao-Hui Huang,Rui-Wu Li,Shu-Fen Ge,Fabio Santanelli, Di Pompeo D'Illasi

doi:10.1371/journal.pone.0074110

Nan Guo, Xue-Xin Tan + Show 10 more

Open Access

https://doi.org/10.1371/journal.pone.0074110

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Abstract

BackgroundThe usage of submental flap is a good method for head and neck reconstruction, but it has some risk also, such as anatomical variations and surgical errors. In this article, we present a modified incision design for the submental flap.MethodsWe designed a modified submental flap incision method based on the overlap of the incision outline of the submental flap, platysma myocutaneous flap and infrahyoid myocutaneous flap. If we found that the submental flap was unreliable during the neck dissection at the level III, II and Ib areas, the infrahyoid myocutaneous flap or platysma myocutaneous flap was used to replace it. Between 2004 and 2012, we performed 30 cases using this method. As control, 33 radial forearm free flaps were counted. Significant differences were evaluated using the χ2 test and Mann-Whitney U. Survival and recurrence were analyzed using the Kaplan-Meier method.ResultsOf the 30 patients, 27 finally received a submental flap, 1 patient received an infrahyoid myocutaneous flap, and 2 patients received a platysma myocutaneous flap. In patients who received the submental flap, the average operation time was 5.9 hours, 2.4 hours shorter than the radial forearm free flap group; the average age was 61.8, 6.1 years older than the radial forearm free flap group; the survival time and recurrence time did not significantly differ with those of the forearm free flap group; and the success rate was higher than traditional methods.ConclusionsThe wider indications, less required time, the similar low risk of recurrence and death as radial forearm free flap, higher success rate than traditional submental flap harvest methods, and ability to safely harvest a submental flap make the modified incision design a reliable method.

Highlights

The variable surgical defects that can result from head and neck tumor operations necessitate a broad range of surgical reconstructions, ranging from primary closures and pedicle flaps to free tissue transfers
To optimize the cosmetic and functional outcomes for any given individual surgical wound, the head and neck surgeon must possess a firm grasp of the fundamental techniques as well as the ability to use a reconstructive modality that meets the unique demands of each defect, as ascertained through a thorough defect analysis [1]
If we found that the pedicle was too thin, too short, had anatomical variations, was damaged, or was too close to the metastatic lymph node, the flap was abandoned

Summary

Introduction

The variable surgical defects that can result from head and neck tumor operations necessitate a broad range of surgical reconstructions, ranging from primary closures and pedicle flaps to free tissue transfers. The usage of submental flap is a good method for head and neck reconstruction, but it has some risk such as anatomical variations and surgical errors. In patients who received the submental flap, the average operation time was 5.9 hours, 2.4 hours shorter than the radial forearm free flap group; the average age was 61.8, 6.1 years older than the radial forearm free flap group; the survival time and recurrence time did not significantly differ with those of the forearm free flap group; and the success rate was higher than traditional methods. Conclusions: The wider indications, less required time, the similar low risk of recurrence and death as radial forearm free flap, higher success rate than traditional submental flap harvest methods, and ability to safely harvest a submental flap make the modified incision design a reliable method

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