Submental flap practice patterns and perceived outcomes: A survey of 212 AHNS surgeons☆
Author links open overlay panelLiyangTangaAndrew T.DaybRebeccaLeecEliGordinbKevinEmerickdUrjeet A.PateleDaniel G.DeschlerdJeremy D.Richmond
a
Department of Otolaryngology-Head and Neck Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, United States of America
b
Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, United States of America
c
UT Houston Medical School, Houston, TX, United States of America
d
Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States of America
e
Department of Otolaryngology-Head and Neck Surgery, John H. Stroger Hospital of Cook County, Chicago, IL, United States of America
Received 21 July 2019, Available online 30 October 2019.

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https://doi.org/10.1016/j.amjoto.2019.102291Get rights and content
Abstract
Objectives
To describe American Head and Neck Society (AHNS) surgeon submental flap (SMF) practice patterns and to evaluate variables associated with SMF complications.

Methods
The design is a cross-sectional study. An online survey was distributed to 782 AHNS surgeons between 11/11/16 and 12/31/16. Surgeon demographics, training, practice patterns and techniques were characterized and evaluated for associations with frequency of SMF complications.

Results
Among 212 AHNS surgeons, 108 (50.9%) reported performing SMFs, of whom 86 provided complete responses. Most surgeons who performed the SMF routinely reconstructed oral cavity defects with the flap (86.1%, n = 74). Thirty-seven surgeons (43.0%) experienced “very few” complications with the SMF. Surgeons who practiced in the United States versus internationally (p = 0.003), performed more total career SMFs (p = 0.02), and routinely reconstructed parotid and oropharyngeal defects (p = 0.04 and p < 0.001) with SMFs were more frequently perceived to have “very few” complications. SMF surgeons reported more perceived complications with the SMF compared to pectoralis major (p = 0.001) and radial forearm free flaps (p = 0.01). However, similar perceived complications were reported between all three flaps when surgeons performed >30 SMF. Among 94 surgeons not performing SMFs, 71.3% had interest in a SMF training course.

Conclusions
Practice patterns of surgeons performing SMFs are diverse, although most use the flap for oral cavity reconstruction. While 43% of surgeons performing the SMF reported “very few” complications, overall complication rates with the SMF were higher compared to other flaps, potentially due to limited experience with the SMF. Increased training opportunities in SMF harvest and inset are indicated.

Keywords
Submental flapRadial forearm free flapPectoralis major flap
☆
Financial disclosure: Nothing to disclose.

Conflict of interest: Nothing to disclose.

Copyright Transfer: In consideration of the American Journal of Otolaryngology's reviewing and editing my submission, “Submental Flap Practice Patterns and Perceived Outcomes: A Survey of 212 AHNS Surgeons,” the author(s) undersigned transfers, assigns and otherwise conveys all copyright ownership to Elsevier Inc. in the event that such work is published in the American Journal of Otolaryngology.

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© 2019 Published by Elsevier Inc.