Introduction: The submental artery island pedicled flap (SMIF) is an underutilized alternative for reconstruction of head and neck defects following tumor ablation. The SMIF possesses the same ideal qualities as the forearm free flap, obviating the need for specialized skills for microvascular anastomosis, a second donor site, shorter operative time and duration of hospital stay.
The purpose of this study was to perform a comparative reconstructive outcomes evaluation based on surgical site and ablative defect volume in patients reconstructed with a SMIF versus those reconstructed using the forearm free flap.
Material and methods: Retrospective chart review of all consecutive patients reconstructed with a SMIF from July 2010 through July 2016 at a tertiary care center. A comparative cohort of radial and ulnar forearm free flaps was selected based upon similar ablative volume defect and surgical site. Data analyzed included: pathology, hospital duration, operative time, blood loss, flap volume and defect size, hospital disposition, speech and swallowing function, tumor recurrence and ECOG performance. All statistical comparisons were assessed by ANOVA.
Results: 12 patients reconstructed with a SMIF were identified and compared with 12 patients reconstructed either with a radial or ulnar forearm free flap with a similar matched ablative volume defect. Average age was 61.8 years (SMIF) vs. 57.9 years (FFF). Most common defect was located in tongue and floor of mouth. Squamous cell carcinoma was the most common pathology identified. Flap volumes were similar 38.79 ml (SMIF) vs. 39.77 ml (FFF). Significant comparative outcomes identified with SMIF reconstruction vs. FFF included; shorter anesthesia times (815 vs. 1209 min; P < 0.001), operative times (653 vs. 1031 min; P < 0.001) and blood loss (223 vs. 398 ml; P= 0.04). Post-operative ECOG performance score increased greater for FFF than for SMIF (+0.33 vs. +1.25; P=0.0019). Complication rates were lower for the SMIF (0.17/patient vs. 0.42/patient) but were not statistically significant. There were no significant differences in speech intelligibility. One patient in each cohort remained feeding tube dependent. One patient in the SMIF cohort developed recurrence at the local surgical site. Mean follow-up was 15.5 months.
Conclusion: This is the first study to compare the submental artery island artery flap versus the forearm free flap for reconstruction of oral cavity defects. The SMIF is a viable surgical option as compared the FFF that can be considered oncologically safe in the N0 neck, allowing for an excellent esthetic reconstruction, with decreased operative time and recipient and donor site morbidity.