A retrospective volume matched analysis of the submental artery island pedicled flap as compared to the forearm free flap: Is it a good alternative choice for the reconstruction of defects of the oral cavity and oropharynx?


Publication date: Available online 12 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Nawaf Aslam-Pervez, Steven J. Caldroney, Amal Isaiah, Joshua E. Lubek
PurposeThe submental artery island pedicled flap (SMIF) is an underutilized alternative for reconstruction of head and neck defects following tumor ablation. The purpose of this study was to perform a comparative evaluation of reconstructive outcomes based on surgical site and ablative defect volume in patients reconstructed with a SMIF versus those reconstructed using the forearm free flap (FFF).MethodRetrospective cohort study of all patients with oral cavity/oropharyngeal defects reconstructed with a SMIF versus a cohort of FFF patients with similar volume defects were compared for oncologic safety and viability of equivalent reconstructive outcomes. All statistical comparisons were assessed by ANOVA and Fisher’s exact test.ResultsAverage age was 61.8 years (SMIF) vs. 57.9 years (FFF). Most common defect was located in tongue with squamous cell carcinoma the most common pathology identified. Flap volumes were similar 38.79 (SMIF) vs. 39.77 mL (FFF). Significant comparative outcomes identified with SMIF reconstruction vs. FFF included; shorter anesthesia times (815 vs. 1209 min; P < 0.001), operative times (653 vs. 1031 min; P < 0.001) and blood loss (223 vs. 398 mL; P= 0.04). Post-operative ECOG performance score increased greater for FFF than for SMIF (+0.33 vs. +1.25; P=0.0019). Recipient site complication rates were lower for the FFF (0.17/patient vs. 0.42/patient), but were not statistically significant. There were equal rates of recurrence at the local surgical site and no differences in speech and swallowing function. Mean follow-up was 15.5 months.ConclusionsThis is the first study to compare the submental artery island flap versus the forearm free flap for reconstruction of oral cavity defects based on ablative volume deficit. The SMIF is a viable surgical option as compared to the FFF that can be considered oncologically safe in the N0 neck, allowing for an excellent esthetic reconstruction, with decreased operative time, hospital stay and donor site morbidity.

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