Proximal facial artery loop mobilization to increase pedicle length and flap reach in submental flap reconstruction: a prospective case series
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Abstract
Objective: To evaluate whether mobilization of the proximal facial artery loops increases pedicle length and flap reach during submental flap reconstruction of orofacial defects.
Methods: This prospective case series was conducted at Rehman Medical Institute, Peshawar, Pakistan, from 2024 to 2025. Seven patients undergoing submental flap reconstruction for orofacial defects located >7 cm from the flap harvest site were included. Two pedicle-lengthening techniques were evaluated: mobilization of the mandibular loop by ligating the distal facial artery and mobilization of the pharyngeal loop through submandibular gland mobilization. Pedicle length gained by each maneuver and postoperative outcomes were recorded. Patients were followed for at least one year.
Results: The mean age was 47.5 years (range: 20–74 years); four patients were male and three were female. Defect sizes ranged from 4×4 cm to 8×8 cm. Pharyngeal loop mobilization was performed in all seven patients, increasing flap reach by a mean of 1.5 cm (range: 1.2–1.8 cm). Mandibular loop mobilization was required in three patients and provided an additional mean pedicle length gain of 1.0 cm (range: 0.9–1.1 cm). Partial donor-site necrosis occurred in five patients, one required rhomboid flap reconstruction, and one developed transient House-Brackmann grade II marginal mandibular nerve weakness. No locoregional recurrence was observed during follow-up.
Conclusion: Mobilization of the proximal facial artery loops effectively increases pedicle length and flap reach, extending the reconstructive versatility of the submental flap for selected orofacial defects while maintaining acceptable morbidity.
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