American Society of Hirudotherapy

Submental flap for reconstruction of anterior skull base, orbital, and high facial defects

Research article published in American journal of otolaryngology (2018)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Research reportClinical TrialsChang BA et al. · American journal of otolaryngology, 2018

Abstract

PURPOSE: Large anterior skull base, orbital, and high facial defects can present a challenging reconstructive problem. Limited data exists in the literature on the use of a submental flap for reconstructing such defects. We aimed to describe the feasibility, success, and advantages of using variations of the submental flap for reconstruction of anterior skull base, orbital, and high facial defects. MATERIALS & METHODS: Outcomes measured included flap method, flap survival, flap size, reconstructive site complications, donor site complications, and length of hospital stay. RESULTS: Nine patients were identified that underwent submental flap reconstruction of anterior skull base, orbital, or high facial soft tissue defects. There were 5 pedicled, 2 hybridized, and 2 free submental flap reconstructions. Flap survival was 100%. One flap required leech therapy for early post-operative venous congestion. Average flap skin paddle size was 63.7 cm2. Average length of hospital stay was 7.3 days. No complications from the donor site were reported. CONCLUSIONS: Different variations on the submental flap are viable options for reconstruction of high defects in the head and neck. Such flaps have a number of unique qualities that are suitable for reconstruction of anterior skull base, orbital, and high facial defects.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Publication typeJournal Article
Indexed MeSH termsAgedAged, 80 and overFaceFemaleFree Tissue FlapsHumansLength of StayMaleOrbitPlastic Surgery ProceduresSkull BaseTreatment Outcome

Summary

Large anterior skull base, orbital, and high facial defects can present a challenging reconstructive problem.

Why This Matters for Hirudotherapy

This study examined outcomes in 9 patients who underwent submental flap reconstruction for anterior skull base, orbital, or high facial soft tissue defects, reporting 100% flap survival with one flap requiring leech therapy for early post-operative venous congestion. This finding holds direct relevance to hirudotherapy because it documents medicinal leech use as a salvage intervention for venous congestion — a well-established application of leech therapy in reconstructive surgery that ASH members should recognize. The study's report that 1 of 9 cases needed leech therapy provides modest real-world context for how frequently this complication and intervention arise. Caveat: this was a small descriptive report of 9 patients without a comparison group, so it cannot establish efficacy, generalizable rates of leech therapy need, or outcomes specific to the leech-treated case.

Citation

Submental flap for reconstruction of anterior skull base, orbital, and high facial defects

Chang BA et al. · American journal of otolaryngology, 2018

DOI

Added to ASH library: May 27, 2026 · Site last updated: June 18, 2026

This website provides educational information and does not constitute medical advice, diagnosis, or treatment recommendations. Medicinal leech therapy carries clinically meaningful risks and should be performed only by qualified clinicians under institutionally approved protocols. FDA 510(k) clearance for medicinal leeches is limited to specific indications; investigational and off-label discussions are labeled accordingly. For patient-specific guidance, consult a qualified healthcare provider.