Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: Reconstruction of complex midface defects is challenging. Vascularized composite flaps are needed to replace missing palatal-maxillary bone, oral and sinonasal lining, as well as external facial skin in these defects. The submental flap has the potential to provide these various tissues with matching facial skin color and hair bearing qualities and is available within the surgical field.
Methods: A retrospective cohort study was carried out at Mayo Clinic Arizona, a quaternary center for head and neck oncology and reconstructive surgery, using STROBE reporting guidelines. Patients who had an osteocutaneous submental flap reconstruction for a midface defect between January 2002 and November 2017 were identified using a prospectively collected database. Patient demographics, surgical characteristics, short-term and long-term complications were collected.
Results: The osteocutaneous submental island flap was utilized for reconstruction of midfacial defects in 15 patients. The mean age of the cohort was 60.45±16.57 years, with a male predominance (73.3%). Squamous cell carcinoma (SCC) was the most common pathology (n=12, 80%). A bony resection was performed in all cases, while additional intra-oral and extra-oral soft tissue resection had to be carried out in 11 and 8 patients respectively. The mean soft tissue component of the flap utilized for reconstruction was 8.6x5.8cm, while the mean bony component harvested was 4.4cm. Short-term complications occurred in three (20%) patients; all required re-exploration in the operating room. Only one patient ultimately experienced flap failure.
Conclusion: The osteocutaneous submental flap is a highly versatile flap that offers excellent bony and soft tissue reconstruction for complex midfacial defects. It provides a rapid, reliable option with minimal donor morbidity and unique color match to the facial defect.