The submental flap – Outcomes and oncologic safety in head and neck reconstruction

Abstract

IntroductionThe submental flap is a reliable alternative to free flaps in the reconstruction of cutaneous facial and oral cavity defects. The thin, pliable, easily harvested flap has minimal donor site morbidity. The flap is controversial due to the potential involvement of level I lymph nodes within the flap. We describe 40 cases of head and neck reconstruction with the submental flap following resection of various cancers, and assess the oncologic safety of this flap at our centre. AimsTo evaluate the outcomes of the submental flap and assess the oncologic safety of the flap on follow-up. Material and methodsPre-operative, post-operative and follow-up data of 40 consecutive patients with oral cavity and parotid malignancies, who underwent reconstruction with the submental flap between January 2017 and June 2019, was analysed. ResultsOral cavity defects following resection of carcinoma tongue were predominant (n = 19). Patients were considered suitable for reconstruction with the submental flap only when level Ia and Ib nodes were clinically and radiologically negative for metastasis. Neck dissection was performed in all cases, with careful dissection of all level Ib nodes along the submental perforators. Flap complications were minimal. During a mean follow-up period of 14 months, no recurrences were noted within the flap. ConclusionsThe submental flap, although not the first choice, is a reliable alternative to free flaps in the reconstruction of oral defects. However, selection of patients with clinically node negative disease is extremely important, due to the potential risk of occult metastasis.