The submental artery pedicled flap for peri-auricular and parotid reconstruction: a comparative cohort

Free tissue transfer (FTT) is commonly used for larger and more complex peri-auricular defects following cutaneous squamous cell carcinoma (cSCC) resection, but it remains resource-intensive and carries significant morbidity. The submental artery pedicled flap, also known as the submental island flap (SIF), is a locoregional alternative with potential advantages. This study aimed to compare perioperative, oncologic, and aesthetic outcomes between SIF and FTT for reconstruction of peri-auricular, parotid, and temporal bone defects secondary to cSCC.

A retrospective cohort study of adult patients undergoing fasciocutaneous reconstruction for cSCC defects at a tertiary center (2015-2023) was performed. Patients received either SIF or FTT. Primary outcomes were operative time, hospital length of stay (LOS), and time from surgery to postoperative radiotherapy (S-PORT). Secondary outcomes included complication rates, skin colour match, and revision surgery.

Among 108 patients, 47 underwent SIF and 61 underwent FTT, 59 which were anterolateral thigh (ALT) flaps. SIF patients were older (78.4 vs 67.5 years, p < 0.01) and had smaller defects (82.3 vs 116.1 mm, p < 0.01). Compared with FTT, SIF had shorter operative times (mean difference 150 min, p < 0.01), reduced LOS (6.2 vs. 8.6 days, p < 0.01), fewer complications (6.4% vs. 27.9%, p < 0;01), and better skin colour match. More SIF patients initiated S-PORT within 42 days (52.9% vs. 27.5%, p < 0.02). Sub-analysis limited to ALT-only flaps demonstrated no meaningful change in outcomes.

Compared with FTT, which consisted predominantly of ALT flaps, SIF is a safe and efficient reconstructive approach, particularly for elderly patients with smaller defects, offering perioperative advantages and improved timeliness of postoperative adjuvant radiotherapy - an established oncologic quality metric.