The radial forearm free flap is the most frequent reconstructive technique. Submental artery island flap in reconstruction of hard palate. B following lower dental clearance, tumour excision and submental island flap reconstruction. Dec 15, 2016 the intraservice work of code 42950 is encompassed in code 15757, which includes harvesting a donor free flap, insetting the free flap at the recipient site using microsurgical technique, and closure of both donor and recipient sites. The submental island flap sif is a pedicled flap based upon the submental artery and vein. Applied anatomy of the submental island flap and its clinical. Pdf submental flap in reconstruction of orofacial defects. Research open access the submental flap for oral cavity. However, its role in composite defects involving the jaw is not clearly defined.
Research open access the submental flap for oral cavity reconstruction. The intraservice work of code 42950 is encompassed in code 15757, which includes harvesting a donor free flap, insetting the free flap at the recipient site using microsurgical technique, and closure of both donor and recipient sites. Submental island flap vs free tissue transfer in oral. To our knowledge, this is the only reported case of fibula free flap mandibular reconstruction in a patient with im, as well as one of the youngest reported submental island flaps for any pathology. Submental flap for reconstruction of anterior skull base.
T2 comparison of outcomes to the radial forearm free flap. The mandibular reconstruction was staged with initial bridging titanium plate with a submental flap, followed later by a fibula free flap. Case reports in surgery hindawi publishing corporation. Background the purpose of this study was to present the feasibility of reconstructing an inferior orbital rim and cheek defect with a pedicled osteomyocutaneous submental flap. This is more so when the resection is total and a complete lip has to be constructed. Reconstruction of the lip commissure with upper and lower lip. The submental island flap is useful as an alternative to microvascular free tissue transfer for the reconstruction of defects after resection of oral cancer because it is simple to harvest. View the article pdf and any associated supplements and figures for a period of 48 hours. Pdf comparison of the submental island artery pedicled. Submental versus platysma flap for the reconstruction of. The submental island flap was first mentioned in the literature by martin et al. A, flap size was notably larger for patients who underwent radial forearm free flap rfff compared with those who underwent submental island pedicled flap sipf p. Original article submental island pedicled flap vs radial. The submental flap is gaining popularity as a simple technique for.
The objective of this study is to demonstrate the oncological safety and benefits of this flap in oral cavity reconstruction in a tertiary care cancer hospital. Submental artery island flap vula university of cape town. Pedicled flap in lingual cancer reconstruction 14377 int j clin exp med 2016. Pdf the submental island flap in head and neck cancer. The submental flap is gaining popularity as a simple technique for reconstruction of small to moderate size defects of the oral cavity. The procedure used in this case was a combination of bilateral nasolabial flaps with a submental flap and. Submental flap in tongue reconstruction reconstructive. Dec 27, 20 this feature is not available right now.
This a case report of a 64 year old male presenting with a. We collected wet specimens of fresh cadaveric heads from the han chinese adult population for applied anatomy of the submental island flap, and followed five patients with pyriform sinus carcinoma after reconstruction surgery using submental island flaps. Mandibular involvement by myofibromatosis is rare, and the extend of bone destruction and reconstruction make this case unique. Split thickness skin grafts, loco regional flaps, and free flaps have been. The submental flap provides an alternative technique in orofacial reconstruction, especially in situations where free flap services are not available. Although submental island artery flap can be harvested for free tissue transfer, its main advantage for intraoral reconstruction is that it can be used as a pedicled flap and tunneled into the defect. The submental island flap is a viable reconstructive option. To our knowledge, this is the only reported case of fibula free flap. Objective this study compared the complications and functional outcomes of patients with oral tongue cancer who had undergone reconstruction using a submental island flap or a radial forearm free. Reconstruction of an inferior orbital rim and cheek defect. The submental artery flap is a reliable source of skin of excellent color, contour, and texture match for facial resurfacing. From march of 2003 to september of 2005, 10 patients nine with intraoral squamous cell carcinoma and one with facial angiosarcoma underwent submental flap reconstruction after surgical extirpation of aggressive orofacial malignancies. The submental island flap is supplied by the submental artery, a branch of the facial artery.
Reconstruction with submental flap for aggressive orofacial. Submental flap as an alternative to microsurgical flap in intraoral. 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. The submental artery island pedicled flap smif is an underutilized alternative for reconstruction of head and neck defects. Then, the contralateral side is separated and the fig. Submental island flap versus free flap reconstruction for.
The submental vessels also supply a territory of skin in the submental area. Mar 14, 2019 the strategy of staging mandibular reconstruction using a plate and submental island flap followed by a delayed fibula free flap is novel. This versatile flap was successfully used for various defects in 19 patients and all flaps have survived with a few minor complications. The procedure used in this case was a combination of bilateral nasolabial flaps with a submental flap and buccal mucosal. This flap is easily incorporated into cases requiring a neck dissection. Dorsal wrist placement for vascularized submental lymph. Bilateral noma, trismus release, free tram and submental. There were 5 pedicled, 2 hybridized, and 2 free submental flap reconstructions. Because of dependent vascular pedicle, wide arch of rotation and less donor site morbidities, it is equally effective to that of a free flap for the oral cavity defect.
Reconstruction of the columella using the prefabricated reverse flow submental flap. Submental flap in reconstruction of orofacial defects. Submental flap is a useful technique for reconstruction of medium to large oral. Nine patients were identified that underwent submental flap reconstruction of anterior skull base, orbital, or high facial soft tissue defects. The nasolabial flap was rotated medially for reconstruction of the upper lip and then folded upon itself to form the inner and outer aspects of the upper lip. Free tissue transfer is nowadays more often performed in the elderly with the increase. Submental versus platysma flap for the reconstruction of complex facial defects following resection of head and neck tumors. The hybrid submental flap for tongue reconstruction todd c. Accordingly, one might expect shorter operative time with the submental island pedicled flap sipf than is seen with free flap alternatives. Method a 77yearold women with a right nasosinusal adenoid cystic carcinoma invading soft tissues and skin of the cheek, the inferior rim of the orbit, the hard palate, and the middle turbinate is presented. Dorsal wrist placement for vascularized submental lymph node. The submental island flap was harvested figure 5, based on the submental branch of the ipsilateral side and after completion of the neck dissection, starting. Submental artery island flap can be used as a pedicle or free flap. Pdf the submental flap is gaining popularity as a simple technique for reconstruction of small to.
Submental definition and meaning collins english dictionary. Original article the submental island flap in lingual cancer. However, a local pedicled flap, such as the submental island flap sif, could be a more effective and less demanding alternative. 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. Your chance to have a onetoone lesson with bestselling language expert paul noble, try a free audio sample of his brand new mandarin chinese course. Submental artery island flap can be used as a pedicle or free flap 3. Extended indications and technical refinements ayman a amin1, mostafa a sakkary1, ashraf a khalil2, mohammmed a rifaat1 and sherif b zayed1 abstract background and purpose.
C, d the appearance of the donor site, 3 months postoperatively. Blood supply of this flap can be retrograded based on facial artery or reverse flow based on angular artery 4,5. Discover a revolutionary approach to reconstructive surgery. The submental island flap 87 figure 6a t2 squamous cell carcinoma of the anterior floor of mouth. Pharyngoplasty with free flap reconstruction karenzupko. Hair bearing nature of this flap in men makes it less appropriate. The most commonly affected areas are the head, the neck and the trunk.
This video shows the use of the submental island flap for the reconstruction of a large oral cavity defect. The musculocutaneous submental flap provides an excellent option for reconstruction of lateral skull base defects given its proximity, reliability, ease of harvest, and exceptional color match. Filmed under the permission of operating plastic surgeon, dr shaji thomas, head and neck surgical oncology unit regional cancer centre india. Infantile myofibromatosis is the most common benign fibrous tumor in infants. Submental island pedicled flap vs radial forearm free flap for. Pdf the submental island flap for palatal reconstruction. Dorsal placement was hypothesized to offer superior outcomes due to favorable venous drainage. In the radial forearm free flap group, partial skin graft loss and arm function restriction were recorded. Infantile myofibromatosis treated by mandibulectomy and. The skin territory of the single pedicle submental island flap is as large as 7. The flap is drained by the submental vein, which in turn drains into the common facial vein on the surface of the submandibular gland. Mean operative time and duration of hospital stay were significantly shorter in the submental island flap group. Therefore, deepithelialized variant is introduced to overcome the problem of hair with this. Pdf submental island flap reconstruction reduces cost in.
The submental flap for head and neck reconstruction. Vascularized lymph node transfer with submental free flap. The strategy of staging mandibular reconstruction using a plate and submental island flap followed by a delayed fibula free flap is novel. The submental island flap journal of plastic, reconstructive. Studies directly comparing smif and ftt for oral cavity defects were included. The submental island flap in head and neck cancer faisal m. Submental artery island flap in reconstruction of hard. The submandibular gland was dissected and left free.
The submental island flap is a viable reconstructive. Pdf the submental flap for oral cavity reconstruction. Since then, many other reports in the literature have confirmed its versatile use in head and neck reconstruction, and it is an excellent option for. This flap has been used successfully in 47 patients.
In the submental island flap group, all the flaps were successfully transferred with no donor site complications. Free flaps, such as the radial forearm and anterolateral thigh flap, have been the mainstay of complex head and neck reconstruction. For larger or more distant defects, an alternative reconstruction method or modification of this flap into a free flap should be considered. One flap required leech therapy for early postoperative venous congestion. Pertinent anatomy the submental island flap is an axial patterned flap based on the submental artery. Surgeons can use the skin and vessels in reconstruction of the face or the oral cavity. First stage reconstruction of a rare, bilateral case of noma using a submental flap, bilateral coronoidectomy for trismus, and a free flap, tram flap by facing africa, surgery, course. Submental flap reconstruction was associated with reduced operative time, hospitalization duration, and flap revisions.
This video is strictly for educational and academic. When the submental artery turns upward over the border of the mandible it divides into a superficial and a deep branch. Submental island flap reconstruction for carcinoma of the. Submental flap is a useful technique for reconstruction of medium to large oral cavity defects. Although the submental flap can be har vested for free tissue transfer, it is most frequently used as a pedicled flap and does not require advanced microvas.
The submental island flap smif is frequently utilized as an alternative to free tissue transfer ftt in oral cavity reconstruction. Submental island flap reconstruction reduces cost in oral cancer reconstruction compared to radial forearm free flap reconstruction. Submental artery islandsubmental artery island flapflap department of oral and maxillofacial surgery vinnitsa national medical university presentation by, patrick royson albertina sheehama supervised by. 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. Lip reconstruction following resection for tumour or following extensive trauma may pose a challenge. We present a case of lip reconstruction following a total resection of the upper lip. The submental island flap can be successfully used for soft tissue reconstruction in the malignancies of the oral cavity with satisfactory outcomes. Vascularized submental lymph node flap transfer to the wrist is an effective treatment for breast cancerrelated lymphedema. Jan 12, 2015 chapter 14 submental island flap introduction. The submental flap is gaining popularity as a simple technique for reconstruction of. The submental island flap for palatal reconstruction. Comparison of outcomes to the radial forearm free flap. Submental island flap versus radial forearm free flap for. Three different types have been reported in the literature.
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. The hybrid submental flap for tongue reconstruction. The principal aspect of the reconstructive possibilities of this flap is well represented in figure 1. The submental artery is a consistent branch of the facial artery. To compare intraoperative, postoperative, functional, and oncologic outcomes of the submental island pedicled flap sipf to the radial forearm free flap rfff. T1 the submental flap for head and neck reconstruction. The pharyngeal reconstruction should be included in code 15757, as it would for wherever the flap was inserted.
Read more study guides for every stage of your learning journey. Applied anatomy of the submental island flap and its. The flap is drained through submental vein into the facial vein. 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 flap for soft tissue reconstruction following. The mission of the ahns is to advance education, research, and quality of care for the head and neck oncology patient.
Unlimited viewing of the article pdf and any associated supplements and figures. 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. Zhongfei xu, shufen ge, junlin li, shaohui huang, xuexin tan, changfu sun 20, modified incision design for submental flap. Although submental island artery flap can be harvested for free tissue.
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