The Hybrid Submental Flap for Tongue Reconstruction

The hybrid submental flap is technically feasible and can be a valuable bailout procedure when aberrant vascular anatomy limits the arc of rotation. Ligation and anastomosis of the vein, versus the artery, is more likely to be required because of the more variable drainage patterns and potential valves that would prevent retrograde flow in a Y-V procedure. Retrograde arterial perfusion through the angular branch of the facial artery, by ligation of the submental artery at its proximal takeoff from the facial artery, is a well-documented method to gain cephalad arc of rotation in cases of restrictive arterial anatomy.