University of the West Indies, Honorary Consultant OMFS/ Head and Neck, Eric Williams Medical Sciences Complex, Uriah Butler, Highway, Champs Fleurs, Trinidad and Tobago.
Head and Neck Surgeon, Hull University hospital, Anlaby Rd, Hull HU3 2JZ, United Kingdom.
Br J Oral Maxillofac Surg. 2023 Apr;61(3):221-226. doi: 10.1016/j.bjoms.2023.01.008. Epub 2023 Feb 27.
The submental island flap has been increasing in popularity for both oncological and non-oncological reconstruction of the head and neck. However, the original description of this flap left it with the unfortunate designation as a lymph node flap. There has thus been significant debate on the oncological safety of the flap. In this cadaveric study the perforator system suppling the skin island is delineated and the lymph node yield of the skeletonised flap is analysed histologically. A safe and consistent approach to raising the perforator flap modification is described and the pertinent anatomy, and an oncological discussion with regards to the submental island perforator flap histological lymph node yield discussed. Ethical approval was received from Hull York Medical School for the anatomical dissection of 15 sides of cadavers. 6 x 4cm submental island flaps were raised following a vascular infusion of a 50/50 mix of acrylic paint. The flap size mimics the T1/T2 tumour defects these flaps would usually be used to reconstruct.The submental vascular anatomy, including length, diameter, venous drainage patterns, and the skin perforator system was documented. The dissected submental flaps were then histologically examined for the presence of lymph nodes by a head and neck pathologist at Hull University Hospitals Trust department of histology. The total length of the submental island arterial system, the distance from where the facial artery branches off from the carotid to the submental artery perforator entering the anterior belly of digastric or skin, averaged 91.1mm with anaverage facial artery length of 33.1mm and submental artery of 58mm. Vessel diameter for microvascular reconstruction was 1.63mm for the submental artery and 3mm for the facial artery. The most common venous anatomy drainage pattern was the submental island venaecomitantes draining to the retromandibular system then to the internal jugular vein. Almost half the specimens had a dominant superficial submental perforator allowing the ability to raise this as a skin only system. There were generally 2-4 perforators passing through the anterior belly of digastric to supply the skin paddle.73.3% (11/15) of the skeletonised flaps contained no lymph nodes on histological examination. The perforator version of the submental island flap can be safely and consistently raised with inclusion of the anterior belly of digastric. In approximately half the cases a dominant superficial branch allows for a skin only paddle. Due to the vessel diameter, free tissue transfer is predictable.Venous anatomy is variable and care needs to be taken when raising this flap. The skeletonised version of the perforator flap is largely devoid of nodal yield and on oncological review a 16.3% recurrence rate is equivalent to current standard treatment.
颏下岛状瓣因其对头颈肿瘤和非肿瘤重建的有益作用而越来越受欢迎。然而，该皮瓣最初的描述使其不幸地被归为淋巴结皮瓣。因此，对于皮瓣的肿瘤安全性存在很大的争议。在这项尸体研究中，对供应皮岛的穿支系统进行了描绘，并对去骨化颏下岛状瓣的淋巴结产量进行了组织学分析。描述了一种安全且一致的方法来提升穿支皮瓣，讨论了相关解剖学，并讨论了颏下岛状穿支皮瓣组织学淋巴结产量与肿瘤的关系。赫尔约克医学院（Hull York Medical School）已批准对 15 侧尸体进行解剖学研究。在血管内注入 50/50 混合丙烯颜料后，掀起了 6 x 4cm 的颏下岛状瓣。该皮瓣的大小模拟了通常用于重建 T1/T2 肿瘤缺损的 T1/T2 肿瘤缺陷。记录了颏下血管解剖结构，包括长度、直径、静脉引流模式和皮穿支系统。由赫尔大学医院信托部的头颈病理学家对解剖的颏下皮瓣进行组织学检查，以检查是否存在淋巴结。颏下岛状动脉系统的总长度为 91.1mm，从颈总动脉分出颌外动脉到进入二腹肌前腹或皮肤的颏下动脉穿支，平均颌外动脉长度为 33.1mm，颏下动脉长 58mm。微血管重建的血管直径为颏下动脉 1.63mm，颌外动脉 3mm。最常见的静脉解剖引流模式是颏下岛状静脉伴行静脉，引流至下颌后静脉，然后引流至颈内静脉。近一半的标本有一个主要的浅表颏下穿支，允许将其作为仅皮瓣系统提起。通常有 2-4 个穿支穿过二腹肌前腹供应皮瓣。73.3%（15/15）的去骨化皮瓣在组织学检查中未发现淋巴结。颏下岛状皮瓣的穿支皮瓣可以安全、一致地提起，包括二腹肌前腹。在大约一半的情况下，一个主要的浅表分支允许形成仅皮瓣。由于血管直径，游离组织转移是可预测的。静脉解剖结构是可变的，在提起该皮瓣时需要小心。穿支皮瓣的去骨化皮瓣几乎没有淋巴结产量，在肿瘤学回顾中，16.3%的复发率与当前的标准治疗相当。
