title: The cervico-submental keystone island flap for locoregional head and neck reconstruction.
abstract: BACKGROUND
  Locally advanced head and neck cancer often requires wide resections of the cheek and parotid gland, and in an ageing population preferred reconstructive options aim to avoid lengthy operating times or high risk surgery. While most large parotid defects traditionally require free flap reconstruction, we describe a new and versatile locoregional flap that has been shown to be reliable, simple and safe.
  
  
  METHODS
  We describe the cervico-submental (CSM) keystone-design perforator island flap for head and neck reconstruction, including an analysis of 33 consecutive patients with a range of head and neck defects. The flap was raised based on perforators of the external carotid artery and its branches, and designed to overlay the C2/C3 dermatomes (an aide memoire for flap design). The indications, and surgical technique are described.
  
  
  RESULTS
  In 33 consecutive patients, no major complications were encountered. Five patients developed superficial infections, one developed post-operative bleeding and one patient developed partial tip necrosis. Theatre time was considerably shorter than our alternative reconstructive options.
  
  
  CONCLUSIONS
  The CSM keystone-design perforator island flap is a novel and versatile flap, which can be used in a range of advanced cheek and parotidectomy defects, and may enable improved surgical management in an increasingly elderly and high-risk population.
authors.affiliation: Department of Surgical Oncology, Peter MacCallum Cancer Centre, St Andrews Pl, East Melbourne, Victoria 3002, Australia.
authors.forename: Felix C
authors.initials: FC
authors.lastname: Behan
authors.forename: Warren M
authors.initials: WM
authors.lastname: Rozen
authors.forename: Jeremy
authors.initials: J
authors.lastname: Wilson
authors.forename: Shivam
authors.initials: S
authors.lastname: Kapila
authors.forename: Andrew
authors.initials: A
authors.lastname: Sizeland
authors.forename: Michael W
authors.initials: MW
authors.lastname: Findlay
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000601:surgery; D015266:Carcinoma, Merkel Cell / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D006801:Humans; D008297:Male; D008545:Melanoma / Q000601:surgery; D008875:Middle Aged; D061646:Operative Time; D019106:Postoperative Hemorrhage / Q000209:etiology*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D013524:Surgical Flaps / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000209:etiology