Objective To evaluate the effectiveness of the submental island flap for repair of oral defects after radical resection of early-stage oral squamous cell carcinoma (OSCC). Methods Between February 2010 and August 2011, 15 cases of early-stage OSCC were treated. Of 15 cases, 9 were male and 6 were female, aged from 48 to 71 years (mean, 63 years). The disease duration was 28-73 days (mean, 35 days). Primary lesions included tongue (3 cases), buccal mucosa (8 cases), retromolar area (2 cases), and floor of mouth mucosa (2 cases). According to TNM classification of International Union Against Cancer (UICC, 2002) of oral cancer and oropharyngeal cancer, 2 cases were classified as T1N0M0 and 13 cases as T2N0M0. The results of the pathologic type were high differentiated squamous cell carcinoma in 11 cases and moderately differentiated squamous cell carcinoma in 4 cases. The defect after resection of the lesion ranged from 5 cm × 3 cm to 8 cm × 6 cm. All the cases underwent radical resection of the primary lesion and immediate reconstruction with submental island flap except 1 case with radial forearm free flap because of no definite venous drainage. The sizes of the submental island flap varied from 6 cm × 4 cm to 9 cm × 6 cm. Results Operation time ranged from 4 hours and 30 minutes to 7 hours and 10 minutes (mean, 5 hours and 53 minutes) in 14 cases undergoing repair with submental island flap. All the flaps survived completely in 13 cases except 1 case having superficial necrosis of the flap, which was cured after conservative treatment. Temporary marginal mandibular nerve palsy occurred in 1 case, and was cured after 3 months; submandibular effusion was observed in 3 cases, and was cured after expectant treatment. The follow-up period ranged from 8 to 15 months (mean, 10.5 months) in 14 cases undergoing repair with submental island flap. Hair growth was seen on the flap and became sparse after 3 months in 2 male cases. The appearance of the face, opening mouth, swallowing, and speech were recovered well in 14 cases, and the donor site had no obvious scar. The follow-up period was 13 months in 1 case undergoing repair with radical free forearm flap, and the appearance and function were recovered well. No local recurrence was found during follow-up. Conclusion The submental island flap has reliable blood supply, and could be harvested simply and rapidly. It can be used to repair oral defects in patients with early-stage OSCC after radical resection.
Objective To explore the appl ication of submental island flaps in repairing pharyngeal fistula after total laryngectomy. Methods From July 2002 to February 2006, 9 cases of concomitant pharyngeal fistula (including 7 cases of laryngeal carcinoma and 2 cases of hypopharyngeal neoplasms) were repaired with submental island flaps after total laryngectomy. All patients were male and their ages were 52-71 years (mean 61.8 years). Pharyngeal fistula occurred 5-62 days (mean 14.7 days) after total laryngectomy. The diameter of medial pharyngeal fistula ranged from 1.9 cm to 4.1 cm. All patients failed to respond to conservative therapy for 25-46 days. The size of submental island flap was 2.5 cm × 2.4 cm to 4.6 cm × 4.0 cm. After the pharyngeal fistula were repaired with submental flap, the donor site were sutured directly. Results All of the nine submental flaps were survived and no local necrosis or wound infection occurred. Incision at donor site healed by first intention and no obvious scar formed. Fistula occurred 10 days after operation and was cured after symptomatic treatment in one patient who received radiotherapy before operation; other patients achieved the satisfactory results of one-stage repair. The gastric tube was pulled out 14 to 22 days after operation, all of the patients have no sense of swallow obstruction. Nine patients were followed up for 10-38 months (mean 27 months). The ppearance of neck was satisfactory. Conclusion Because of its short distance, abundant blood supply, convenient operation and minimal donor-site morbidity, the submental island flap is a good alternative mthod in repairing pharyngeal fistula.
Objective To study the feasibility, surgical techniques, and results of submental island flaps for reconstruction of hypopharyngeal noncircumferential defects. Methods A retrospective review of the archives was performed on 16 patients（6 males, 10 females, aged 41-78 years）who suffered from hypopharyngeal cancer. From August 1998 to August 2002, the patients underwent a partial removal of the hypopharynx and reconstruction by submental island flaps. Their hypopharyngeal carcinomas belonged to squamous carcinoma. Of the 16 patients (2 in UICC clinical stage Ⅱ, 11 in Ⅲ, 3 in Ⅳ), 9 had their pathologicalorigin in the pyriform sinus, 4 in the posterior pharyngeal wall, and 3 in the postcricoid. The flap area ranged from 8.0 cm×4.5 cm to 5.0 cm×3.0 cm. Results The follow-up for 3-7 years showed that the submental island flaps healed well in all patients with a success rate of 100%. The swallowing function returned to normal 1014 days after operation without complications of salivary fistula and infection. The 3-year and 5-year survival rates were 68.8% (11/16) and 62.5% (5/8), respectively. Conclusion Submental island flaps are convenient for reconstruction of hypopharyngeal noncircumferential defects, and they are safe and reliable, too.
Objective To evaluate the clinical significance of submental island flap in repairing tongue defects.Methods Nine patients (6 men and 3 women)with tongue squamous cell carcinoma underwent subtotal or partial glossectomy, resection of mandible,radical neck dissection and immediate reconstruction of tongue defects with submental island flap. The age ranged from 48 years to 71 years, the lesion locations were right part of tongue (5 cases) and left part of tongue (4 cases). The defect sizes were 4.2 cm×3.2 cm to 5.5 cm×4.0 cm. The flap area rangedfrom 6.0 cm×3.0 cm to 7.0 cm×4.0 cm. The flap pedicle included submental artery in 8 cases and both submental artery and facial artery in 1 case. Results The submental island flap survived in 8 cases. Postoperative articulation and swallowing were investigated in all cases. The static shape of tongue after rec onstruction with submental island flap was acceptable. The dynamic speech, swallowing and food transport function were well preformed. No complication occurred.Three patients were given radiotherapy 3 weeks after operation. Conclusion It is simple and convenient to repair defects of tongue and oral floor with submental island flap.