Salvaging a submental flap

Surgery for oral malignancies is usually followed by reconstruction of the defect. Free flaps remain the ideal choice for reconstruction, but advocating for it may not be possible in all circumstances. The submental artery-based island flap (SMIF) is a well-known local flap for its high reliability, versatility and arc of rotation; however, venous congestion is a major reason for its failure.A 50-year-old man underwent surgery for carcinoma gingivobuccal sulcus, which involved reconstruction of the oral defect with SMIF. The flap developed venous congestion 17 hours following surgery. The flap was immediately re-explored and could be salvaged. There was no flap loss or recipient/donor site morbidities during follow-up.Immediate re-exploration of the submental flap, undergoing venous congestion, can prevent a flap loss. Close monitoring for flap changes is mandatory in the immediate postoperative period for SMIF, especially for those with altered venous drainage.