Osteocutaneous Submental Flap for Midface Reconstruction: Cohort Study and Description of Technique

Reconstruction of complex midface defects is challenging. Vascularized composite flaps are often needed to replace missing premaxilla and palatal bone, oral and sinonasal lining, as well as external facial skin in these defects. The submental flap has the potential to provide all these various tissues with the added advantage of matching facial skin color and hair-bearing qualities and is available within the surgical field.

A retrospective cohort study was carried out at Mayo Clinic Arizona. Patients who had an osteocutaneous submental flap reconstruction for a midface defect between January 2002 and November 2017 were identified using a prospectively collected database. Patient demographics, surgical characteristics, short-term and long-term complications were collected.

The osteocutaneous submental island flap was utilized for reconstruction of midfacial defects in 15 patients. The mean age of the cohort was 60.45 ± 16.57 years, with a male predominance (73.3%). Squamous cell carcinoma was the most common pathology (n = 12, 80%). The mean soft tissue component of the flap utilized for reconstruction was 50cm², with the mean bone length harvested being 4.4 cm. Short-term complications occurred in three (20%) patients requiring re-exploration in the operating room. One patient ultimately experienced flap failure.

The pedicled osteocutaneous submental flap is a highly versatile flap that offers excellent bony and soft tissue reconstruction for complex midfacial defects. It provides a rapid, reliable option with minimal donor morbidity and a unique color match to the facial defect.