Hybrid submental flaps for reconstruction in the head and neck: part pedicled, part free

Evaluate feasibility and success of elongating only the venous pedicle of the submental flap to increase the superior arc of rotation for the "hybrid" flap allowing coverage of more distal defects.

Retrospective evaluation of all submental flaps undergoing pedicle-lengthening procedure at a single institution.

Medical records were reviewed for all patients undergoing reconstruction with submental flaps between 2002 and 2012. Information regarding demographics, etiology, location, size, and extent of defects, type of submental flap harvested, operative time, and outcomes were recorded. Special note was made of vascular pedicle length and any pedicle vessel manipulation to increase the superior arc of rotation.

Nine patients (67% male) with a mean age of 61 years (range, 25-83 years) underwent hybrid submental flap procedures. Eight surgical defects resulted from cancer ablation and one from trauma. Five flaps were musculocutaneous, and four were osseomusculocutaneous. The divided pedicle vein was anastomosed to the external jugular vein (n = 6), retromandibular vein (n = 1), common facial vein (n = 1), and internal jugular vein (n = 1). Pedicle vessel elongation averaged 5 cm. Skin paddle size averaged 71 cm(2) (range, 48-99 cm(2)). All donor sites were closed primarily with no further surgery required. One flap experienced venous thrombosis and was successfully salvaged. Overall flap survival was 100%. No local or regional cancer recurrence was detected in the cancer patients with a mean follow-up of 20 months (range, 3-87 months).

The hybrid submental flap safely extends the arc of rotation 5 cm, allowing coverage of defects in the forehead, temporal-parietal, and occipital regions.