Reverse-flow submental artery flap for periorbital soft tissue and socket reconstruction.

BACKGROUND The submental artery island flap is a recently described local flap that may be used for reconstruction of the lower and middle thirds of the face and oral cavity. The reverse-flow manner of the flap has been used in limited cases because of possible drawbacks such as venous congestion. We present our experience with the use of reverse-flow submental artery flap and describe the surgical technique. METHODS This versatile flap was successfully used for large periorbital soft-tissue defects and socket reconstruction in six patients in the past 2 years. The diagnosis of three patients was basal cell carcinoma of the eyelids, which required orbital exenteration, and the other patient had traumatic periorbital defects. The flap size varied from a minimum of 4 x 6 cm to a maximum of 6 x 8 cm. RESULTS No major complications were noted other than one case of temporary palsy of the marginal mandibular branch of the facial nerve and one other of venous congestion, which subsided spontaneously. In all patients, the results were satisfactory, with acceptable cosmesis. CONCLUSIONS The reverse-flow submental artery island flap is safe, rapid, and simple to raise and leaves a well-hidden scar. We believe that this flap surpasses the other flaps in reconstruction of large periorbital soft-tissue defects and socket.