Sonographic Evaluation of the Submandibular Region and Perforators Mapping Before Harvesting a Submental Flap May Reduce Vascular-Related Complications

The submental flap (SF) may serve as an alternative to free flap microvascular reconstruction in the head and neck region for appropriately selected patients. However, despite its apparent simplicity, the SF can be associated with a significant incidence of vascular complications affecting the transferred tissues. The aim of this study was to evaluate the usefulness of preoperative color Doppler ultrasonography (CDU) in planning the submental flap. A total of 62 patients with oral cavity cancers who underwent reconstruction using the submental flap were included. In the first group, perforators and the vascular course were assessed preoperatively using CDU. The second group comprised retrospectively selected patients who did not undergo preoperative perforator mapping. Perforators were most commonly located lateral to the digastric muscle. We observed a lower overall incidence of flap perfusion disorders in patients who underwent CDU evaluation (6 versus 1; P=0.105). Moreover, these patients required fewer reoperations. In conclusion preoperative sonographic assessment of the submandibular region should be performed on all patients for whom SF reconstruction is planned. This approach enables precise identification of vessels and their trajectories, facilitating safer and more efficient flap elevation.