How I Do It: The Submental Flap in Head and Neck Reconstruction

The submental flap is a reliable and versatile regional reconstructive option for small-to-moderate defects of the oral cavity, buccal mucosa, oropharynx, hypopharynx and lower face. Based on the submental artery, a consistent branch of the facial artery, this pedicled flap offers thin, pliable tissue with excellent color and texture match to the surrounding facial skin. Compared to microvascular free tissue transfer, it provides shorter operative time, lower perioperative risk, and ease of harvest, making it particularly advantageous in elderly patients and those with significant comorbidities. In this article, I describe my current technique for harvesting and applying the submental flap, refined over years of experience. Key principles include mandatory inclusion of the ipsilateral anterior belly of the digastric muscle for perforator preservation, contralateral-to-ipsilateral subplatysmal dissection, meticulous identification of venous outflow pathways during concurrent neck dissection, and careful management of oncologic risk in oral cavity cancer. With proper planning and technique, the submental flap provides consistent, reproducible outcomes with minimal donor-site morbidity.