[The submental flap: Anatomical study of pedicle elongation].

Abstract

Introduction: Martin's first description of the submental flap in 1990 (Martins, 1990) made it possible to reliably cover the lower two-thirds of the face. Although deemed difficult due to its intricated vascular, muscular and nerve anatomy, this flap has quickly gained in popularity. Its increasingly frequent use has made it possible to describe dissection steps at the level of the facial vessels and venous drainage system to gain arc of rotation. However, to date, no study has measured the gain in arc of rotation related of the dissection performed.

Objective: To find out the gain in arc of rotation depending of the dissection performed at arterial and venous level. We also describe the course of the submental artery in relation to the anterior belly of the digastric muscle.

Method: Twelve flaps were made on six fresh cadavers, previously injected with colored latex. Measurements were taken with a reference line between the external canthus and the root of the helix.

Results: Of the eleven flaps including the submental artery, dissection of the facial artery to its origin at the level of the external carotid artery resulted in an average gain of 2.3cm. The YV venous lengthening resulted in an additional average gain of 0.8cm. In all cases, the submental artery was located deeper than the anterior belly of the digastric muscle.

Conclusion: Pedicle elongation techniques include dissection of the facial artery to its origin, as well as YV venous procedure. The choice should be dictated by the area to be covered. The gain in arc of rotation is substantial after dissection of the facial artery and appears moderate and technically difficult with venous lengthening.