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Twenty-Five Years of Experience with the Submental Flap in Facial Reconstruction

Evolution and Technical Refinements following 311 Cases in Europe and Africa

Bertrand, Baptiste, M.D., Ph.D.; Honeyman, Calum Sinclair, M.R.C.S.(Ed.), B.Sc.(Hons.); Emparanza, Angel, M.D.; McGurk, Mark, F.R.C.S.; Ousmane Hamady, Issa Elh, M.D.; Schmidt, Andreas, M.D.; Sinna, Raphael, M.D., Ph.D., M.B.A.; Pittet-Cuénod, Brigitte, M.D.; Zwetyenga, Narcisse, M.D., Ph.D.; Martin, Dominique, M.D., Ph.D.

Plastic and Reconstructive Surgery: June 2019 - Volume 143 - Issue 6 - p 1747–1758
doi: 10.1097/PRS.0000000000005678
Reconstructive: Head and Neck: Original Articles
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Discussion

Background: The submental flap is a pedicled island flap with excellent color match for facial reconstruction. The flap can be raised with muscle, submandibular gland, or bone and can be transposed to reach defects up to two-thirds of the face. The authors report the primary author’s (D.M.) experience of 25 years using the submental flap from its original description to most recent technical evolutions in both Europe and Africa.

Methods: This is a retrospective study including all patients with facial defects who underwent reconstruction using a submental flap between 1991 and 2016. This study included the use of all four variations of the submental flap: platysmal, digastric, extended, and superextended. The authors report technical adaptations and complications encountered.

Results: The authors performed 311 facial reconstructions using submental flaps: 32 platysmal, 133 digastric, 91 extended, and 45 superextended variations. In conjunction with these reconstructions, the authors performed 10 osteocutaneous submental flaps and two free flaps. The authors report two cases of total flap necrosis (0.6 percent) and 28 minor complications, including 23 cases of distal skin necrosis (7 percent), one reversible mandibular facial nerve palsy (0.3 percent), and three hematomas (1 percent).

Conclusions: The submental flap has proven to be a reliable flap for head and neck reconstruction. The four technical modifications described use varying amounts of soft tissue to replace tissue lost and can include vascularized bone from the mandibular margin. This flap exemplifies Gillies’ principle of “replacing like with like” and should be discussed as an alternative to free tissue transfer in facial reconstruction, especially in settings where resources are limited.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Marseille, Amiens, and Dijon, France; Livingston, Scotland; London, United Kingdom; San Sebastian, Spain; Niamey, Niger; and Geneva, Switzerland

From the Department of Plastic and Reconstructive Surgery, La Conception Hospital, Assistance Publique–Hôpitaux de Marseille; the Department of Plastic and Reconstructive Surgery, St. John’s Hospital; the Department of MaxilloFacial and Plastic Surgery, Clinica Teknibai, Calle Federico García Lorca; the Department of Oral and Maxillofacial Surgery, Guy’s and St Thomas’ NHS Trust; the Department of Plastic and Reconstructive Surgery, Hilfsaktion Noma Hospital; the South Bavaria Section of Interplast Germany; the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU Picardie; the Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals; the Department of Oral and Maxillofacial Surgery, Department of Plastic and Reconstructive Surgery, CHU de Dijon; and private practice.

Received for publication March 11, 2018; accepted November 14, 2018.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

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Baptiste Bertrand, M.D., Department of Plastic and Reconstructive Surgery, La Conception Hospital, AP-HM, 147 Boulevard Baille, 13005 Marseille, France, baptiste.bertrand@gmail.com, Instagram: @batbertrand

©2019American Society of Plastic Surgeons