An anatomic study and clinical applications of the reversed submental perforator-based island flap

The authors present their experience with the reversed submental perforator-based island flap for nose reconstruction and their anatomic and clinical studies. There have been several descriptions on the reversed pattern of the submental flap, but its anatomic background and clinical availability are still questionable. The submental area was analyzed by anatomic dissection on four fresh cadavers that were injected with a barium mixture. The anatomic data were accumulated with the authors' clinical experience with eight patients treated with a submental island flap. On the basis of these studies, the location of reliable perforators was constant at the lateral and/or medial border of the anterior belly of the digastric muscle, but their locations were not always symmetric on both sides in the submental territory. Unlike the comitant submental vein, another larger superficial vein has a different course before reaching the lateral border of the anterior digastric belly, and therefore, it must be included in the reversed flap. The premised anatomic results and the clinical experience prove the reliability of the reversed submental perforator-based island flap as a versatile option in midface reconstruction, including the nose, once the dissection has been carefully done, respecting the anatomic points that can be found in this study.