This is an extremely useful local pedicle flap, or it can be used as a free flap. The submental artery flap is a well described axial pattern flap that is increasingly being used in head and neck reconstruction because of its obvious advantages. Doppler identification of perforator vessels preceded preoperative planning and the flap harvesting followed the dissection of perforator vessels. The submental island flap is a local flap that is simple to raise and is useful for oral and lower face reconstruction of soft tissue defects. Despite its incidence, it is commonly a treatable disease, with a 90% 5year survival rate and an 83% 10year survival rate. Please note that this postponement is a fully equivalent replacement for the planned event originally scheduled on march 2020. Save up to 80% by choosing the etextbook option for isbn. Submental flap adds a new source of soft tissue in this area, offering benefits of an axial pattern flap with a large paddle size, in the vicinity of the mandible, 14. Applied anatomy of the submental island flap and its. Submental perforator flap design with a nearinfrared.
Extended indications and technical refinements ayman a amin1, mostafa a sakkary1, ashraf a khalil2, mohammmed a rifaat1 and sherif b zayed1 abstract background and purpose. Submental flaps for facial and intraoral defect coverage were first described in 1993. The pap flap is an alternative to abdominal based donor sites for autologous breast reconstruction in patients where the abdomen is undesirable or contraindicated. Preexpanded perforator flaps, an issue of clinics in plastic. Definition and introductiondefinition and introduction the submental artery island flap saif is an axial pattern flap introduced by martin et.
Clinical application of submental artery perforator flap in oral and. In this study, we evaluated submental flap design by employing nearinfrared nir fluorescence angiography to identify perforator. Submental flap is a useful technique for reconstruction of medium to large oral cavity defects. Dec 20, 2011 the submental flap is gaining popularity as a simple technique for reconstruction of small to moderate size defects of the oral cavity. The submental island flap in head and neck cancer faisal m, adeel. An otolaryngologist performed closure of septal perforation with a pedicled inferior turbinate mucosal flap. Perforator flaps for breast reconstruction download. Supraclavicular artery island flap for reconstructing defects in the head and neck region. With coverage of nearly twice the number of flaps as the previous edition, flaps and reconstructive surgery, 2nd edition provides trainees and practicing surgeons alike with the detailed, expert knowledge required to ensure optimal outcomes. The first ever international course on perforator flaps icpf was organized in gent, belgium, 20 years ago in 1997, when perforator flap surgery was still in its pioneering phase. These flaps are based on the submental artery, a branch of the facial artery, and have an anterior neck skin paddle which can be an inconspicuous donor site 8, 9.
Program thursday, august 24, 2017 cadaver labs cadaver lab dissection the ohio state university hamilton hall room 256258 columbus, oh 43210 shuttle service provided from grand event center to ha. The submental island flap for palatal reconstruction. This study was to investigate the anatomy and distribution of vascularized submental lymph node vsln flap using magnetic resonance imaging mri and their clinical outcome. To the best of our knowledge, this is the first case in english literature of a submental perforator flap reconstruction of a malignant melanoma defect. For the successful reconstruction of facial defects, various perforator flaps have been used in singlestage surgery, where tissues are moved to adjacent defect sites. However, its role in composite defects involving the jaw is not clearly defined. Comparisons of submental and groin vascularized lymph node. It is based on the submental artery and the facial vein. We then incised through skin and subcutaneous tissue with the knife using electrocautery. However, oncologically sound neck dissection should be assured. The specimens were then subjected to gross observation and. Because the donor vessels have traversed muscle before reaching the fascia, a longer vascular pedicle can be dissected.
The submental perforator flap was useful for reconstructing skin defects on the cheek and the chin, because the site of the submental perforator was stable and raising the flap was easy, and the. The experience of the department of oral and maxillofacial surgery of the h. The submental artery island flap sif is an axial fasciocutaneous flap that includes skin, subcutaneous tissue, platysma, and fat and is pedicled on the submental artery and veins figures 1, 2. Vascularized groin and submental lymph node flaps are both effective surgical options in treating bcrl. What started as a small meeting among friends, has grown into a major international forum where colleagues share their new ideas in the field of perforator. Submental perforator flap for softtissue reconstruction. The submental island flap is an axial patterned flap based on the submental artery. The submental flap provides an alternative technique in orofacial. The design of the soft tissue defect can be transposed to a paper template, which is placed on the submental region. Submental artery island flap in reconstruction of hard palate. Patients were followed at monthly interval till 6 months in the postoperative period. The flap dimensions needed are outline, with the perforator on the longitudinal axis of the flap. It marks a new era in reconstructive surgery where surgeons are no longer bound by the traditional conventions of flap surgery.
Preexpanded perforator flaps, an issue of clinics in plastic surgery authors. Perforator flap definition of perforator flap by medical. This study assessed the reliability of the reverse facial artery submental artery mandibular osteomuscular flap for. The submental flap is a valid option for reconstruction of intraoral soft tissue as well as composite oral defects particularly in elderly patients.
This flap can reduce donorsite morbidity significantly and is a good choice for reconstructive surgery. In this paper, simultaneous reconstruction of the upper lip and moustache is described. Freestyle local perforator flaps for facial reconstruction. Register for trial choose your licence package for full free access during a 14day test period. We use cookies to make interactions with our website easy and meaningful, to better understand the use of our services, and to tailor advertising. This results in an ellipse with its anterior longitudinal arc skirting the lateral border of the latissimus. Hair bearing nature of this flap in men makes it less appropriate.
Current concept and definition, abstract the term perforator flap, used to define a new type of flap, has recently been introduced in the medical field and in the clinical practice of plastic surgeons. To harvest the flap the superior limb of the skin paddle is raised and the lateral incision made through the platysma muscle. This video demonstrates an axial propellar flap based on the facial artery from the nasolabial area for reconstruction of a nasal side wall defect after basal cell carcioma excision. Methods between august 2006 and december 2008, 22 patients with lower face defects or deformity underwent reconstruction with pedicled submental artery perforator flaps. Its utility in reconstruction following ablative head and neck procedures has been applied to various subsites including skin, lip, buccal mucosa, retromolar trigone, parotidectomy defects, and tongue. Review of perforator flaps in head and neck cancer surgery. Vy advancement for chin reconstruction thornton, james fallon m. This low percentage has been attributed to lack of both information and access. Additional features in this edition include highly useful modifications of elevation of the radial forearm flap as well as new chapters on the rectus abdominis flap, a reliable option for covering deep and extended defects, and the medial sural perforator flap. This international meeting usually held in amiens france is coming to the united states for the first time. Indeed, controversy exists about the flap s interference with an oncologically sound neck dissection a total of 21 patients with oral cavity cancers over a three year period were. The buccal mucosa 12 patients, tongue 10 patients and floor of mouth 8 patients were the subsites in the oral cavity. Suffix s is added if the flap is harvested based on direct septal or fasciocutaneous vessels. Perforator flaps are described according to the main artery of origin e.
It includes chapters and expert commentaries from more than 100 authors and worldrenowned leaders in the field, while brandnew cases and highquality. The use of submental artery perforator island flap without including digastric muscle in the reconstruction of lower face and intraoral defects. The arterial system was perfused with red dye emulsion, while the venous system was infused with blue dye emulsion. The submental artery is a consistent branch of the facial artery. Submental flap in reconstruction of orofacial defects.
The buccal mucosa 12 patients, tongue 10 patients and floor of mouth 8. Supraclavicular artery island flap iowa head and neck. Here it gives off perforators to the subdermal plexus which perfuses platysma and skin. Submental flap in tongue reconstruction reconstructive. Propeller flap for perineal sinus reconstruction youtube. The patient underwent a second surgical operation under general anesthesia and nasotracheal intubation, consisting of a transverse incision in the neck and harvesting of a submental perforator flap, including the submental vein and artery in the flap. Freestyle perforator flaps were applied to get better cosmetic facial reconstruction. This is the most common procedure performed at our breast center as women generally have excess skin and fat along the lower portion of their abdomen.
Applied anatomy of the submental island flap and its clinical. Perforator flap perforator flap meeting 2017 columbus ohio. The submental flap is gaining popularity as a simple technique for reconstruction of. Initial descriptions of perforator flaps in 1989 by koshima and soeda, by using a musculocutaneous flap with an inferior epigastric arterybased skin island for reconstruction of defects involving the floor of mouth and groin, have led to significant additional advancements in the understanding of perforator flaps and vascular anatomy. Dear friend, 3rd flap reconstruction course on cadaver is postponed to october 15th 17th, 2020 please mark your calendars. Therefore, deepithelialized variant is introduced to overcome the problem of hair with this. Ramon y cajal of madrid from 2009 to 20 is described, using the records of a total of 20 reconstructions made with submental pedicled flap in patients with intra and extraoral cancers. The flap is drained through submental vein into the facial vein. It includes chapters and expert commentaries from more than 100 authors and worldrenowned leaders in the field, while brandnew cases and high. The hybrid submental flap for tongue reconstruction. Development of vascularized submental lymph node vsln flap has encountered dilemmas. Pu and chunmei wang, is devoted to preexpanded perforator flaps. Reconstruction of large chin defects requires a flap suitably matched with the contour, colour, and tissue texture of this important aesthetic facial unit. A perforator flap should be named after the nutrient artery or vessels and not after the underlying muscle.
The hybrid submental flap for tongue reconstruction todd c. Amiens perforator flap conference in conjunction with the annual ruberg symposium. In this study, we evaluated submental flap design by employing nearinfrared nir fluorescence angiography to identify perforator arteries pas. All women who undergo mastectomy are candidates for consideration of perforator flap breast reconstruction when natural tissue reconstruction is preferred over implant reconstruction. It arises deep to the submandibular gland and may be deep 70% or superficial 30% ref 8a to the digastric muscle.
Applied anatomy of the submental island flap path of the submental artery and accompanying veins. Perforator flaps the history of evolution jun 2002 robert j. Keystone and pedicle perforator flaps in reconstructive. Ishihara t1, igata t, masuguchi s, matsushita s, sakai k, ihn h. Musculocutaneous perforator flaps offer advantages over musculocutaneous flaps, including reduced donor site morbidity, more predictable reconstruction of soft tissue deformities, and a wider variety of flap options. Submental artery island flap in intraoral reconstruction. We also discuss increasingly popular perforator flaps such as the submental flap for the head and neck. Along its course, cutaneous perforators pierce the platysma and. The use of submental artery perforator island flap without. This study solve this problem by securing submental flap to remaining palate by bone sutures. Using a surgical approach through the neck, marginal mandibulectomy was performed with a.
Other readers will always be interested in your opinion of the books youve read. The submental island flap sif is a pedicled flap based upon the submental artery and vein. Ten head specimens 20 sides were collected from han adult cadavers. Melolabial flap oral cavity reconstruction youtube. Breast cancer is a common diagnosis, with 252710 new invasive cases and 63410 in situ cases diagnosed annually, according to the american cancer society data in 2017. Whether youve loved the book or not, if you give your honest and detailed thoughts then people will find new books that are right for them. Accurate prediction of submental lymph nodes using. Mar 07, 2019 body lift perforator flap reconstruction uses a flap of tissue from both sides of the lower abdomen diep and the upper buttocks sgap, or hip flap to reconstruct the breasts two flaps per breast, or four flaps in all. This new edition has been updated to include ten new chapters and extensive updates on all existing chapters. The osu department of plastic surgery is pleased to announce. Diep stands for the deep inferior epigastric perforator artery, which runs through the abdomen. The vsln flap for bcrl provides more significant improvements in limb circumference, lesser total complication rate, a faster flap harvest time, and perhaps the most important factor. Baudet editorial comment use of the submental area as donor tissue for reconstruction of facial defects has depended on the description of the anatomy by these authors. Filmed under the permission of operating plastic surgeon, dr shaji thomas, head and neck surgical oncology unit regional cancer centre india.
The perforator can be at the center, distal or proximal aspect of the flap, depending on the needed orientation in the recipient area. Our group successfully performed perforator flap surgery on 17 patients with small to moderate facial defects that affected the functional and aesthetic features of their faces. The positions of these perforators that perfuse the submental is land are. We used a doppler to find several perforator candidates. Operating from the central idea that it is necessary to preserve the integrity of the dermatome with its innervation and vascularisation, the. Surgical anatomy of vascularized submental lymph node flap. Elevation of the flap using a perforator pedicle without the use of muscle has been reported, and the submental perforator was demonstrated as being reliable. The submental artery perforator flap is a thin and reliable flap with robust blood supply.
To summarize the clinical anatomical features and surgical technique of the submental artery perforator flap smapf, and to evaluate. The submental artery perforator flap has a long vascular pedicle and is useful in facial and intraoral reconstructions. Submental perforator flap reconstruction of a malignant. Free style perforator flaps for aesthetic facial reconstruction. Submental artery islandsubmental artery island flapflap department of oral and maxillofacial surgery vinnitsa national medical university presentation by, patrick royson albertina sheehama supervised by. With coverage of nearly twice the number of flaps as the previous edition, flaps and reconstructive surgery, 2 nd edition provides trainees and practicing surgeons alike with the detailed, expert knowledge required to ensure optimal outcomes. Currently, 3 million women are living with the disease.
True submental artery perforator flap for total softtissue chin. Many new developments have taken place in the field, including the use of local perforator flaps, including freestyle propeller flaps as well as. Seven parts organized anatomically detail flaps used for the headneck, chest, back, abdomen, pelvis, upper extremity, and lower extremity, followed by an. It has been championed as an alternative to the tug flap.
If there is a potential to harvest multiple perforator flaps from one vessel, the name of each flap should be based on its anatomical region or muscle. Many of the contributors to perforator flaps for breast reconstruction have pioneered the procedures presented in their respective chapters. The skin territory of the single pedicle submental island flap is as large as 7. A comparative study between submandibularfacial artery island flaps including perforator flap and submental artery perforator flap. The perforator arteries were detected and labeled with a handheld doppler flowmeter. We then designed a propeller perforator flap around the possible perforators to be used. The conventional submental island flap is raised based on the digastric muscle belly. Submental lymph node transfer has proved to be an effective approach for the treatment of lymphedema. Sep 27, 2016 thirtyone facial defects were reconstructed with freestyle local perforator flaps between january 2007 and november 2014. Reconstruction of lower face defect or deformity with. The tie between perforator flaps and skin flaps as well as perforator flaps and musculocutaneous flaps is explained. We collected wet specimens of fresh cadaveric heads from the han chinese adult population for applied anatomy of the submental island flap, and followed five patients with pyriform sinus carcinoma after reconstruction surgery using submental island flaps. The profunda femoris artery supplies the tissue of the posterior thigh through musculo and septocutaneous perforators. Suffix ap artery perforator signifies a true musculocutaneous perforator flap.
The keystone perforator island flap elsevier australia. Perforator flaps for breast reconstruction 1st edition. The submental flap is gaining popularity as a simple technique for reconstruction of small to moderate size defects of the oral cavity. Original article the submental island flap in lingual cancer.
A licence package is needed for accessing this content. Nasolabial flaps were the first true perforator flaps in the face used to reconstruct perioral defects. The submental flap is a reliable alternative to microsurgical reconstruction of facial deformities, providing an excellent cosmetic match with the contour and color of the face. An anatomical basis for the flap using a pedicle containing a cervical, nonperforating cutaneous branch of. The diep flap is the technique where skin and tissue no muscle is taken from the abdomen in order to recreate the breast. Although many free flap procedures have become popular in maxillary reconstruction, these microsurgical methods have certain limitations and risks. Threedimensional angiography of the submental artery. We use cookies on our website, only to provide you with a better service. Craniomaxillofacial trauma and reconstruction will be of interest to specialists working in ophthalmology, oral and maxillofacial surgery, otolaryngology, plastic and reconstructive surgery, dentistry, facial plastic surgery and trauma surgery.
Raising of microvascular flaps a systematic approach. Perforator flap surgery was described as extravagant and exceptional in those days but it has now become the mainstream reconstructive technique for restoring defects throughout the body. An assessment of the anatomical basis of the thoracoacromial. This book is an essential authoritative guide for plastic surgeons interested in making perforator flap reconstruction part of their practice. Reconstruction of intraoral defects after resection of. Breast reconstruction free flaps statpearls ncbi bookshelf. The submental island flap is a viable reconstructive. Submental island flap was utilized for the reconstruction of the soft tissue defect in each patient. We then performed a spy angiography and found 1 or 2 areas which confirmed our suspected doppler locations. Feb 28, 2019 overall, only 1516% of these mastectomy patients undergo reconstruction.