title: Submental Artery Flap with Sentinel Lymph Node Biopsy in the Reconstruction of Oral Cancer.
abstract: BACKGROUND
  Microvascular free flaps form the gold standard for reconstruction of defects after intraoral cancer surgery, but not all patients are suitable candidates for microsurgery. The submental artery flap is an alternative to free tissue transfer especially in patients who do not tolerate extensive operations due to major comorbidities. However, in metastatic neck disease, this option has not been recommended due to theoretical intraoral transfer of cancer cells. The aim of this study was to consider the indications and benefits of the submental artery perforator flap in patients with intraoral cancer.
  
  
  METHODS
  Ten patients with early (N = 2) or locally advanced (N = 8) intraoral cancer, who were not candidates for free tissue transfer because of major comorbidities, were managed with tumor resection and coverage of the defect with the submental artery flap. The minimum follow-up time for all patients was 6 years.
  
  
  RESULTS
  The average defect size was 5 × 9 cm. Two patients developed major complications and one of them had a flap loss. Sentinel lymph node biopsy was used in three cases to rule out positive neck disease close to the flap pedicle. During the follow-up time 6 out of 10 patients had a local recurrence and there were no appearances of metastatic neck disease.
  
  
  CONCLUSIONS
  The submental artery flap is an alternative option to intraoral microvascular reconstruction in patients with major comorbidities. Sentinel lymph node biopsy can be used as an adjunct to enhance oncological safety.
authors.affiliation: Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Annastiina
authors.initials: A
authors.lastname: Husso
authors.affiliation: Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Sinikka
authors.initials: S
authors.lastname: Suominen
authors.affiliation: Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Tahsin Oguz
authors.initials: TO
authors.lastname: Acarturk
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Leif
authors.initials: L
authors.lastname: Bäck
authors.affiliation: Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Patrik
authors.initials: P
authors.lastname: Lassus
authors.affiliation: Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Jyrki
authors.initials: J
authors.lastname: Vuola
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Mäkitie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000637:transplantation*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply*; D006085:Graft Survival; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology / Q000601:surgery*; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D018579:Patient Selection; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D000071036:Sentinel Lymph Node / Q000473:pathology / Q000601:surgery*; D021701:Sentinel Lymph Node Biopsy; D016896:Treatment Outcome