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Submental Flap in Facial Reconstructive Surgery: Long-Term Casuistry Revision

Tassinari, Juri M.D.; Orlandino, Gianfranco M.D.; Calabrese, Luca M.D.; Fabrizio, Tommaso M.D.

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Plastic and Reconstructive Surgery: September 2010 - Volume 126 - Issue 3 - p 139e-140e
doi: 10.1097/PRS.0b013e3181e3b570
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Sir:

From 1994 to 2008, we performed reconstruction with the submental flap in 47 patients affected by skin cancer of the face. Table 1 lists the principal features of the casuistry. The soft texture and light thickness of the flap sculptured in the best way the facial contour of the removed cancer area.1,2

Table 1
Table 1:
Principal Features of the Casuistry

Forty-seven patients were enrolled between 1994 and 2008. There were 28 men and 19 women, with ages ranging from 48 to 84 and with an average age of 70 years. The follow-up period ranged from 4 to 120 months, with an average of 47.5 months. The size of the skin paddle ranged from 6 × 4 cm to 15 × 7 cm, with an average size of 11.2 × 6 cm. Thirty patients had squamous cell cancer, 11 had basal cell cancer, nine had parotid adenocarcinoma, and one had malignant melanoma. Cancer was present in four different areas: in the cheek in 46.8 percent, the temporal area in 23.4 percent, the parotid region in 19.1 percent, and the lower lip in 10.6 percent. The longest postoperative period was 14 days and the shortest was 5 days.3,4

This flap has been used successfully in 47 patients. The principal aspect of the reconstructive possibilities of this flap is well represented in Figure 1. When facial reconstruction with local flaps after skin tumor removal has failed or a very large demolition of the face is mandatory, the submental flap could be a very important alternative to other complicated flaps, microsurgical flaps included, for the reconstruction of large defects of the middle face.

Fig. 1.
Fig. 1.:
(Above, left) Squamous cell carcinoma of the inferior left eyelid and zygomatic region. (Above, right) Local recurrence with multiple cutaneous metastases and reconstruction with a local flap. (Below, left) Magnetic resonance imaging scan of the recurrence. (Below, right) One-year cosmetic result after cancer removal and reconstruction with a very large submental flap.

We believe that the submental flap, at the present time, could be considered as the first-choice flap for the reconstruction of middle size defects of the head and neck region.5

Juri Tassinari, M.D.

Gianfranco Orlandino, M.D.

Unit of Plastic Reconstructive Surgery

Istituto Scientifico Oncologico

Rionero in Vulture, Italy

Luca Calabrese, M.D.

Unit of Head and Neck

Istituto Europeo di Oncologia

Milan, Italy

Tommaso Fabrizio, M.D.

Unit of Plastic Reconstructive Surgery

Istituto Scientifico Oncologico

Rionero in Vulture, Italy

PATIENT CONSENT

The patient provided written consent for the use of Figure 1.

REFERENCES

1.Martin D, Baudet J, Mondie JM, Peri G. The submental island skin flap: A surgical protocol. Prospects of use (in French). Ann Chir Plast Esthet. 1990;35:480–484.
2.Kim JT, Kim SK, Koshima I, Moriguchi T. An anatomic study and clinical applications of the reversed submental perforator-based island flap. Plast Reconstr Surg. 2002;109:2204–2210.
3.Pistre V, Pelissier P, Martin D, Lim A, Baudet J. Ten years of experience with the submental flap. Plast Reconstr Surg. 2001;108:1576–812.
4.Demir Z, Velidedeoluğlu H, Celebioğlu S. Repair of pharyngocutaneous fistulas with the submental artery island flap. Plast Reconstr Surg. 2005;115:38–44.
5.Tan O, Atik B, Parmaksizoglu D. Soft-tissue augmentation of the middle and lower face using the deepithelialized submental flap. Plast Reconstr Surg. 2007;119:873–879.

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