The submental island flap in head and neck reconstruction: A 10-year experience examining application, oncologic safety, and role of comorbidity

Abstract

Background: We present our experience on reconstructive versatility and risk of nodal transfer with the submental island flap (SIF). We also examine the role of comorbidity as a predictor of complications. Methods: Retrospective cohort study of patients undergoing SIF over 10-year period. Comorbidity determined using Adult Comorbidity Evaluation 27 index (ACE-27). Univariable/multivariable logistic regressions performed to determine association of these characteristics and rates of major complications. Results: Fifty-eight patients underwent SIF reconstruction, 27 (45%) patients had moderate/severe comorbidity, and 24 (41%) experienced major complication. Multivariable analysis identified ACE-27 scores >2 predictive of major flap complications (OR: 17.38, 95% CI: 1.96–153.74, p =.01) and medical complications (OR: 5.8, 95% CI: 1.11–30.23, p =.037). There were no cases of pathologic nodal transfer. Conclusion: The SIF is a versatile flap and oncologically safe in carefully selected patients. The ACE-27 index is strongly predictive of major postoperative complications. Level of Evidence: 4.