Free Musculocutaneous Submental Flap for Reconstruction of Anterior Skull Base Defects

Background: The submental flap is a local flap ideally suited to reconstruction of head and neck defects due to its proximity, ease of harvest, reliability, color-match, and pleasing esthetic outcomes. Utilization of this flap for midface and anterior skull base defects has been limited, largely secondary to insufficient vascular pedicle length required to reach these regions. We present our experience with the submental flap for reconstruction of anterior skull base defects utilizing free tissue transfer techniques.

Methods: A retrospective review of patients undergoing submental flap reconstruction for anterior skull base defects at a single academic tertiary referral center between 2002 and 2013 was conducted. Data was collected on demographics, primary pathology, reconstruction, postoperative course, and outcomes.

Results: Two patients were identified undergoing submental flap reconstruction for anterior skull base defects. One patient had a squamous cell carcinoma of the anterior skull base treated by combined endoscopic and craniofacial resection, subfrontal craniotomy, orbital exenteration, and dural resection. The second patient had a history of squamous cell carcinoma of the anterior skull base treated previously by anterior craniofacial resection, subfrontal craniotomy, orbital exenteration, and partial frontal lobectomy. He presented with hardware infection and required extensive debridement of the prior orbitofrontal craniotomy site. Both patients were reconstructed using a myocutaneous submental flap. Due to insufficient venous pedicle length and inadequate arterial vascular supply using a reverse-flow pattern, both flaps were transferred with free arterial and venous anastomoses. The largest flap was 10 cm × 6 cm in size. There were no postoperative complications and 100% flap survival. Both patients are currently alive without evidence of disease recurrence.

Conclusions: The submental flap provides an ideal option for reconstruction of head and neck defects with exceptional esthetic outcomes. With application of free tissue transfer techniques, the myocuaneous submental flap's functionality is expanded to include reconstruction of defects at the midface and skull base.