Local and regional flaps in head and neck reconstruction. Original article the submental island flap in lingual cancer. Anatomy of veins, arteries and submental island the submental artery supplies a large skin ding from one angle of the mandible to the other. View the article pdf and any associated supplements and figures for a period of 48 hours. Pdf the submental island flap in head and neck cancer. Pdf submental flap in reconstruction of orofacial defects. Dec 11, 2016 an island flap design isolates an island of skin on a vascularized deep fatty pedicle, 4,57 a deep muscular pedicle, 8 a lateral fatty pedicle, 911 a muscular sling, 12, or a dedicated axial vascular bundle 14,15. Island pedicle flaps introduction subcutaneous island pedicle flaps allow for substantial tissue mobilization. Submental island flap vula university of cape town. A technical update objectives in recent years, the submental island flap has demonstrated decreased cost and morbidity as compared with free tissue transfer. Elzahaby, sameh roshdy, fayez shahatto and osama hussein. The submental island flap smif is frequently utilized as an alternative to free tissue transfer ftt in oral cavity reconstruction.
The submental island flap is an axial patterned flap based on the submental artery. Oislando is created when skin is completely incised on all 3 sides. This was a 7yearold patient with moderate acute malnutrition. The submental island flap for reconstruction of intraoral. The required area of skin and tissue is moved without interrupting the blood supply. A, harvested sif before transfer into the oral cavity. The research was designed to test the safety and efficacy of submental island flap as one stage reconstructive procedure for large postsurgical rmt oral defects. This study enrolled patients who underwent sf reconstructive surgery in a tertiary referral center between november 2009 and october 2016.
Elevation of the flap using a perforator pedicle without the use of muscle has been reported, and the submental perforator was demonstrated as being reliable. Submental island flap versus radial forearm free flap for. After the description by pallua et al 6 of the sai flap in 1997, much of the literature that followed described its use in treating cervical scar contracture. Applied anatomy of the submental island flap and its clinical. Ideal for oral and maxillofacial surgeons, facial plastic surgeons, and head and neck surgeons, the book serves as a useful guide to planning reconstructive. Indeed, controversy exists about the flaps interference with an oncologically sound neck dissection a total of 21 patients with oral cavity cancers over a three year period were.
The use of submental island flap for total lower lip reconstruction. The present study aims to assess the usefulness of submental artery flap in oral reconstruction with respect to flap reliability, cosmesis, function, donor site morbidity and oncological safety. Such course may complicate submental island flap harvesting, as well as the graft manipulations and reattachment, since the vein could be damaged during the conventional procedure. Metal plate repair associated with a submental flap, about one case abstract fulltext html xml download as pdf size. Pdf the submental flap is gaining popularity as a simple technique for reconstruction of small to. The microsurgical techniques with free flaps are the gold standard in the immediate reconstruction of postcancer defects of the head and neck. In the submental island flap group, all the flaps were successfully transferred with no donor site complications. Hair bearing nature of this flap in men makes it less appropriate. Successful tongue reconstruction should restore swallowing, speech function, and cosmesis. Discover a revolutionary approach to reconstructive surgery.
This report therefore extends current knowledge of the variations of the vascular anatomy of the head and neck. Repair of pharyngocutaneous fistulas with the submental artery island flap. This study was done to evaluate the functional outcomes of tongue reconstruction using submental flap for tongue defects. Patients underwent compartmental tongue resection with reconstruction using island submental flap. The skin territory of the single pedicle submental island flap is as large as 7. The flap can be raised as an island flap as well as a pedicled flap. The submental island flap was first mentioned in the literature by martin et al. In summary, the submental island flap is an optimal choice for hypopharyngeal defects following tumor resection, because of the abundant blood supply, ease of harvest, high survival rate, unique flexibility, and advantage in retaining laryngeal function. Isbn 9781118340332 local and regional flaps in head neck reconstruction. Submental island flap vs free tissue transfer in oral cavity reconstruction. Compartmental tongue resection with submental island flap reconstruction for large carcinoma of the oral tongue. Superficial head and neck vessels are increasingly used in surgical procedures and are especially important in facial transplantation surgeries. A practical approach provides comprehensive, stepbystep instruction for flap raising and insetting for the head and neck region.
En bloc resection of a c2c3 upper cervical chordoma. Submental island flap and bone variation operative techniques in. An anatomic study and clinical applications of the reversed submental perforatorbased island flap. T2 tongue cancer with or without infiltration of floor of the mouth. Submental island flap is an axial skin flap pedicled. Apr 01, 2008 the conventional submental island flap is raised based on the digastric muscle belly. Manual blunt dissection of the mylohyoid muscle and its inclusion in the submental island flap increases efficiency and reliability. We report a case of mandibular sequela noma requiring plastic surgery. Click download or read online button to get atlas of regional and free flaps for head and neck reconstruction book now. In our case reports, we were able to resurface a soft tissue defect following complete excision and release of a linear widescar contracture band over medial or lateral edge of the popliteal fossa with a modified type i keystone flap design. Original article the submental island flap in lingual. Over the past decade, the submental island flap has.
In 1996, for the first time, sterne and hall reported the use of the submental island flap for reconstruction in oral cancer 2. Dec 20, 2011 the submental flap is gaining popularity as a simple technique for reconstruction of small to moderate size defects of the oral cavity. In 1996, for the first time, sterne and hall reported the use of the submental island flap. Hairbearing submental artery island flap for reconstruction. Submental artery island flap in reconstruction of hard palate. A case report yuxing guo, md 1 chi mao, md1 1department of oral and maxillofacial surgery, peking university school and hospital of stomatology, beijing, china facial plast surg 2016. This video shows the use of the submental island flap for the reconstruction of a large oral cavity defect. Variant course of the submental vein umek folia morphologica. The submental flap provides an alternative technique in orofacial. Now in its second edition, the atlas of regional and free flaps for head and neck reconstruction delivers clear, heavily illustrated coverage of regional skin, muscle, and musculocutaneous flaps as well as donor sites from distant regions of the body where vascularized skin, muscle, bone, and nerves can be harvested and transferred. In this paper, simultaneous reconstruction of the upper lip and moustache is described.
Atlas of regional and free flaps for head and neck. The submental island flap was first described by martin et al. In the radial forearm free flap group, partial skin graft loss and arm function restriction were recorded. Mean operative time and duration of hospital stay were significantly shorter in the submental island flap group.
Submental flap is a useful technique for reconstruction of medium to large oral cavity defects. Submental artery island flap in reconstruction of hard. A balance must be established between releasing restraint and maintaining a sufficient blood supply to ensure flap viability. Advancing education, research, and quality of care for the head and neck oncology patient. Pdf the submental flap for oral cavity reconstruction. The conventional submental island flap is raised based on the digastric muscle belly. To compare intraoperative, postoperative, and functional results of submental island pedicled flap sipf against radial forearm free flap rfff reconstruction for tongue and floorofmouth reconstruction. Vascular anatomy is a determining factor of successful.
Submental flap in reconstruction of orofacial defects. The construction of the pedicle determines both the mobility and the vascularization of the flap. The submental island flap in lingual cancer reconstruction. The use of submental island flap for total lower lip. Noma is a severe and mutilating gangrenous stomatitis of the orofacial sphere, starting on periodontal side. It arises deep to the submandibular gland and may be deep 70% or superficial 30% ref 8a to the digastric muscle.
This is accomplished by selectively and carefully disrupting connections to the surrounding tissues to elevate and mobilize a subcutaneous pedicle. The vascular anatomy of submental flaps sfs represents a determining factor in successful sf raising. Jun 21, 2017 this study was done to evaluate the functional outcomes of tongue reconstruction using submental flap for tongue defects. Applied anatomy of the submental island flap and its. The adequacy of lymph node harvest in concomitant neck. Combined submentaltongue flap for reconstruction of. In recent years, the submental island flap has been increasingly used in the reconstruction of head and neck defects. Studies directly comparing smif and ftt for oral cavity defects were included. Jan 12, 2015 the submental artery island flap is a type c fasciocutaneous flap with its dominant pedicle based on the submental artery, which arises approximately 56. From august 2016 to june 2017, patients receiving submental flap for tongue reconstruction were included in the study all patients had class ii defect. The facialsubmental artery island flap can reliably be used for reconstruction of the lower and middle thirds of the mediumsized oral and maxillofacial defects and the reverse pattern for.
The submental artery island flap sif is an axial fasciocutaneous flap that includes skin, subcutaneous tissue, platysma, and fat and is pedicled on the submental artery and veins figures 1, 2. Dec 20, 2011 an anatomic study and clinical applications of the reversed submental perforatorbased island flap. Combined submentaltongue flap for reconstruction of subtota. The submental flap is an alternative reconstruction technique in the maxillofacial field in cases where the. The submental artery is a consistent branch of the facial artery. Submental island flap vs free tissue transfer in oral. We report a variant course of the submental vein observed during a dissection of a 79yearoldmale embalmed cadaver. Osteoradionecrosis in osseous free flap reconstruction. May 19, 2017 this is a prospective study that was carried out from june 2012 to january 2015 for patients with carcinoma affecting oral tongue. With the pinch test, the width of the flap was determined, and the flap was elevated from the opposite side toward the pedicle.
However, procedures are complex, requiring a high degree of specialisation, and not exempt from complications and morbidity. This is a prospective study that was carried out from june 2012 to january 2015 for patients with carcinoma affecting oral tongue. Since this description, the submental island has struggled to gain a strong foothold as a reliable flap in the reconstruction of head and neck defects. It is rare and occurs mainly in children that land is weakened by malnutrition. Address for correspondencechi mao, md, department of oral and. Island flap definition of island flap by medical dictionary. After designing skin paddle the, first step was to identify facial artery and vein. Chordoma, en bloc, oncology, spine, submental island flap introduction only 45% of chordomas arise in the cervical spine. The submental flap is a valid option for reconstruction of intraoral soft tissue as well as. Vascular anatomy is a determining factor of successful submental flap raising.
The submental island flap journal of plastic, reconstructive. Ideal for oral and maxillofacial surgeons, facial plastic. From august 2016 to june 2017, patients receiving submental flap for tongue reconstruction were included in the study. The submental island flap is supplied by the submental artery, a branch of the facial artery. Basic flap design, palatal island flap, tongue flap, facial artery musculomucosal. Thus, the present study aimed to investigate sf venous return. The submental island flap is a versatile pedicle flap for reconstruction of head and neck. Therefore, deepithelialized variant is introduced to overcome the problem of hair with this flap. Ideal for oral and maxillofacial surgeons, facial plastic surgeons, and head and neck surgeons, the book serves as a useful guide to planning reconstructive cases and an easily accessible reference prior to.
The submental artery is a branch of the facial artery that runs on the underside of the chin. The submental artery is a welldefined and consistent branch of the facial artery. Browse more than 12,000 surgery videos and save your favorites for free. There are no restrictions, and colleagues are welcome to use, copy and quote as they wish. This flap is easily incorporated into cases requiring a neck dissection. Unlimited viewing of the article pdf and any associated. Indeed, controversy exists about the flap s interference with an oncologically sound neck dissection a total of 21 patients with oral cavity cancers over a three year period were. The flap is drained by the submental vein, which in turn drains into the common facial vein on the surface of the submandibular gland. However, little attention has been focused on the venous return of sfs.
The submental flap is gaining popularity as a simple technique for reconstruction of small to moderate size defects of the oral cavity. The flap comprises skin, subcutaneous fat, platysma muscle, submental fat, and lymph nodes. Submental island flap including the anterior belly of digastric b. Submental artery island flap in reconstruction of harde plate iranian journal of otorhinolaryngology no. The submental artery is the largest of the cervical branches of the facial artery, given off just as that vessel leaves the submandibular gland. Submental island pedicled flap vs radial forearm free flap. Compartmental tongue resection with submental island flap reconstruction for large. However, its role in composite defects involving the jaw is not clearly defined. The adequacy of lymph node harvest in concomitant neck block dissection and submental island flap reconstruction for oral squamous cell carcinoma. Objective to compare intraoperative, postoperative, and functional results of submental island pedicled flap sipf against radial forearm free flap rfff reconstruction for tongue and floorofmouth reconstruction.
Recently, application of this flap has been introduced in maxillofacial trauma patients. Compartmental tongue resection with submental island flap. The flap is drained through submental vein into the facial vein. Deltopectoral flap edit the deltopectoral flap is beneficial for reconstruction of significant cheek defects, offering up to 250 cm2 of transferable cutaneous tissue to allow reconstruction of the entire cheek. Rich vascular supply comes from subcutaneous muscular pedicle. Consequently, this article presents our experience of this flap in reconstruction of lingual defects with the anatomy, surgical technique, advantage. The submental artery island flap sif is gaining acceptance as a simple and reliable option in selected oral oncologic reconstructions. Locally advanced head and neck cancer often requires wide resections of the cheek and parotid gland, and in an ageing population preferred reconstructive options aim to avoid lengthy operating times or high risk surgery. The supraclavicular artery island flap in head and neck. In another case, anastomotic stenosis was observed following pyriform sinus carcinoma resection, which was repaired using a submental island flap 7 cm.
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