title: The submental island flap: pedicle elongation and indications in head and neck reconstruction.
abstract: BACKGROUND
  The submental island flap is an axial pattern skin flap first described by Martin et al. in 1993. When used to reconstruct skin defects it matches the recipient site in terms of colour, texture and thickness. One of the main limitations to its application is the arc of the pedicle allowing coverage of only the lower two thirds of the face.
  
  
  METHODS
  A retrospective review was performed of all patients who had had a submental island flap reconstruction at the Operative Unit of Maxillo-Facial Surgery of the University Hospital of Parma, Italy, between 2001 and 2011. The Authors focused on the surgical technique adopted, the clinical indications and the results obtained. They analysed the different ways to elongate the pedicle and discuss their thoughts on the choice of reconstruction. A flowchart was created to help in the decisional process.
  
  
  RESULTS
  Between 2001 and 2011 the submental island flap was used to reconstruct head and neck defects in 22 patients. Thirteen patients had defects of the oral cavity; the remaining 9 patients had skin defects involving the pre-auricular region, the temporal area and the peri-nasal cheek skin. No major complications occurred and in one case a partial necrosis of the distal portion of the flap was observed. Five patients underwent surgical revision involving intraoral flap debulking 6-10 months after the primary procedure.
  
  
  CONCLUSIONS
  The techniques to elongate the pedicle used and described were: additional dissection of the pedicle, Y-V procedure, reverse flow flap, section of facial vein and microvascular anastomosis. Their choice is mainly conditioned by the site of the defect.
authors.affiliation: Maxillo-Facial Surgery, Head and Neck Department, University of Parma, Via Gramsci 14, 43100 Parma (Pr), Italy.
authors.forename: S
authors.initials: S
authors.lastname: Ferrari
authors.affiliation: Maxillo-Facial Surgery, Head and Neck Department, University of Parma, Via Gramsci 14, 43100 Parma (Pr), Italy. Electronic address: chiaracopelli@hotmail.it.
authors.forename: C
authors.initials: C
authors.lastname: Copelli
authors.affiliation: Maxillo-Facial Surgery, Head and Neck Department, University of Parma, Via Gramsci 14, 43100 Parma (Pr), Italy.
authors.forename: B
authors.initials: B
authors.lastname: Bianchi
authors.affiliation: Maxillo-Facial Surgery, Head and Neck Department, University of Parma, Via Gramsci 14, 43100 Parma (Pr), Italy.
authors.forename: A S
authors.initials: AS
authors.lastname: Magri
authors.affiliation: Maxillo-Facial Surgery, Head and Neck Department, University of Parma, Via Gramsci 14, 43100 Parma (Pr), Italy.
authors.forename: A
authors.initials: A
authors.lastname: Ferri
authors.affiliation: Maxillo-Facial Surgery, Head and Neck Department, University of Parma, Via Gramsci 14, 43100 Parma (Pr), Italy.
authors.forename: A
authors.initials: A
authors.lastname: Varazzani
authors.affiliation: Maxillo-Facial Surgery, Head and Neck Department, University of Parma, Via Gramsci 14, 43100 Parma (Pr), Italy.
authors.forename: T
authors.initials: T
authors.lastname: Poli
authors.affiliation: Maxillo-Facial Surgery, Head and Neck Department, University of Parma, Via Gramsci 14, 43100 Parma (Pr), Italy.
authors.forename: T
authors.initials: T
authors.lastname: Ferri
authors.affiliation: Maxillo-Facial Surgery, Head and Neck Department, University of Parma, Via Gramsci 14, 43100 Parma (Pr), Italy.
authors.forename: E
authors.initials: E
authors.lastname: Sesenna
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D002610:Cheek / Q000601:surgery; D003663:Decision Trees; D004427:Ear Diseases / Q000601:surgery; D004431:Ear, External / Q000601:surgery; D005153:Facial Neoplasms / Q000601:surgery; D005260:Female; D006257:Head / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery; D009333:Neck / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012535:Scalp / Q000601:surgery; D012878:Skin Neoplasms / Q000601:surgery; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps / Q000098:blood supply / Q000637:transplantation*
keywords: Head and neck defects; Pedicle elongation; Submental island flap