Head and Neck Reconstruction using The Submental Flap

Abstract

  The submental flap is a minimally invasive option in head and neck reconstruction, because elevation of the flap is simple and accompanied by low donor site morbidity. In this study, we utilized the submental flap after ablative surgery of head and neck cancer for 6 patients. There were no complications except one partial flap loss. The reason for partial flap loss was the deficiency of skin perforator from the submental artery around the lateral border of the anterior belly of the digastric muscle. As a recent cadaveric study demonstrated that skin perforators were mostly located around the medial border, rather than the lateral border of the anterior belly of the digastric muscle, it might be desirable to center the skin island of the flap around the medial border.
  The submental vessels are located in the submandibular region, which is the frequent site of nodal metastases from head and neck cancer. When using the submental flap for head and neck cancer patients, preoperative evaluation of negative nodal metastases in the submandibular region (level I) is essential. In addition, preparation of countermeasures in case of encountering possible nodal metastases during flap elevation would be desirable.
  With sufficient knowledge of the anatomy of the submental artery and its skin perforator, the submental flap can be used safely for head and neck cancer patients.