The submental flap in facial reconstruction: advantages and limitations.
OBJECTIVE
Complex defects resulting from surgical excision of facial cancer sometimes require reconstruction using microvascular free tissue transfer. Tissue transfer from areas distant from the face can resolve many problems, but often provides a poor cosmetic match with facial skin. The submental flap helps surmount this problem. Cervical skin has similarities with face skin, and because this is a regional flap, it helps eliminate microsurgical risks. In this article we present a series of 9 cases, review the anatomy and the surgical technique, and explain the advantages and limitations of the submental flap.


METHODS
A successive series of 9 patients in which this reconstruction was performed was reviewed retrospectively, and the results were analyzed.


RESULTS
Submental flap facial reconstruction was performed on 9 patients (8 men and 1 woman) between 1993 and 2004. Mean patient age was 53.6 years (range, 43 to 81 years). Eight of the 9 external skin coverage cases were associated with excision of cutaneous malignancies; 1 case involved treatment of burn sequelae. There were no cases of marginal mandibular nerve palsy. In 6 cases, venous drainage was disrupted after raising the flap, but without causing flap loss. This disruption was overcome in 4 to 5 days without the need for flap revision or any other interventions. Partial loss of the distal extent of the flap occurred in 2 cases. In all cases, moderately good skin color and texture match was achieved. Debulking of the flap was needed in 6 cases. The donor site recovered well with no hypertrophic scarring and no restriction to neck movement.


CONCLUSIONS
The submental artery island flap is a useful reconstructive procedure that offers options to the reconstructive surgeon and has definite advantages over distant flaps in terms of ease of dissection and donor site appearance.
Abouchadi
Abdeljalil
A
Department of Plastic Surgery, Hôpital Roger Salengro, Center Hospitalier Regional Universitaire de Lille, LilleCedex, France. abdeljalil_abouchadi@hotmail.com
Capon-Degardin
Nathalie
N
Patenôtre
Philippe
P
Martinot-Duquennoy
Veronique
V
Pellerin
Philippe
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002056:Burns / Q000601:surgery; D005145:Face / Q000601:surgery*; D005153:Facial Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000601:surgery; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps / Q000098:blood supply; D016896:Treatment Outcome