Submental Island Flap for Oral Cavity Reconstruction

The submental island flap can cover surprisingly complex defects without microsurgical anastomoses — but its reliability depends on understanding the anatomy in detail.

Oleksandr Kosenko walks through flap design and harvest from a surgeon’s perspective: the submental vascular pedicle, relationships with the digastric and mylohyoid muscles, facial vessels, submandibular gland, marginal mandibular branch of the facial nerve, and hypoglossal nerve. He explains how vessel mobilization changes the arc of rotation and why his technique intentionally includes specific muscles with the flap.

The lecture then moves from anatomy to real head-and-neck oncology cases: reconstruction of cheek, floor-of-mouth, tongue and mandibular-region defects, including patients after previous treatment and neck dissection. Particularly useful are the cases that did not heal perfectly — partial flap necrosis, venous congestion, postoperative remodeling and the practical decisions made during recovery.

The discussion also covers donor-site planning with the pinch test, flap fixation inside the oral cavity, postoperative care, intraoral hair growth, long-term mucosal-like transformation of the skin paddle, and the oncologic limitations of using this flap when cervical lymph-node metastases are present.