Cheek reconstruction with VY, cervicofacial and submental flap

  • Domen Vozel Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
  • Albin Stritar Department of Plastic Surgery and Burns, Division of Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
Keywords: Facial Neoplasms, Facial Injuries, Wound Closure Techniques, Mohs Surgery, Myocutaneous Flap


The cheek occupies the largest facial area and is a common location of acquired soft-tissue defects. They are most frequently caused by trauma and skin malignomas. The latter demand radical tumour excision with safety margins and, consequentially, a significant tissue loss. Large tissue gaps cannot be covered by primary closure; therefore, we must consider the reconstruction with VY, cervicofacial or submental flap. A cervicofacial flap was used to cover gaps along the entire nasolabial fold in the first aesthetical subunit of the cheek, VY to cover large gaps in superomedial part of the first subunit, and submental to cover gaps in the second subunit. We describe in detail characteristics, flap harvest techniques, and present three clinical cases. For a better understanding of the article, we also describe aesthetical subunits, skin lines and part of the facial anatomy.


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De Sousa A. Psychological issues in acquired facial trauma. Indian J Plast Surg. 2010 Jul;43(2):200–5.
Al Shetawi AH, Quimby A, Fernandes R. The Cervicofacial Flap in Cheek Reconstruction: A Guide for Flap Design. J Oral Maxillofac Surg. 2017 Dec;75(12):2708.e1–6.
Weerda H. Basic Principles of Facial Surgery. V: Reconstructive Facial Plastic Surgery: A Problem-solving Manual. 2. izd. Thieme; 2001. str. 5–19. (Thieme Publishers Series).
Heller L, Cole P, Kaufman Y. Cheek reconstruction: current concepts in managing facial soft tissue loss. Semin Plast Surg. 2008 Nov;22(4):294–305.
Alhamdi A. Facial skin lines. Iraqi JMS. 2015;13(2):103–7.
Borges AF. Relaxed skin tension lines (RSTL) versus other skin lines. Plast Reconstr Surg. 1984 Jan;73(1):144–50.
Fattahi TT. An overview of facial aesthetic units. J Oral Maxillofac Surg. 2003 Oct;61(10):1207–11.
Braun TL, Maricevich RS. Soft Tissue Management in Facial Trauma. Semin Plast Surg. 2017 May;31(2):73–9.
Probst R, Grevers G, Iro H. Tumors of the External Nose nad Face. In: Basic otorhinolaryngology: a step-by-step learning guide. 2. izd. Stuttgart; New York : Thieme, cop. 2006.; 2017. str. 62–3.
Chinnadurai S, Janus JR, Moore EJ. Algorithm for the repair of cheek defects. Laryngoscope. 2011 Jan;121(1):137–41.
McGregor AD. Flaps. V: Fundamental techniques of plastic surgery and their surgical applications. Edinburgh: Churchill Livingstone; 2000. str. 61–120.
Fernandes R. Flap classification. V: Local and Regional Flaps in Head and Neck Reconstruction : A Practical Approach. 1. izd. Wiley Blackwell; 2015. str. 2–4.
Hayden RE, Nagel TH, Donald CB. Hybrid submental flaps for reconstruction in the head and neck: part pedicled, part free. Laryngoscope. 2014 Mar;124(3):637–41.
Hallock GG. Further Clarification of the Nomenclature for Compound Flaps. Plastic and Reconstructive Surgery. junij 2006.;117(7):151E-160E.
Mathy JA, Pribaz JJ. Prefabrication and Prelamination Applications in Current Aesthetic Facial Reconstruction. CLINICS IN PLASTIC SURGERY. julij 2009.;36(3):493+.
Goldschlager R, Rozen WM, Ting JW, Leong J. The nomenclature of venous flow-through flaps: updated classification and review of the literature. Microsurgery. 2012 Sep;32(6):497–501.
McGregor AD. Free skin grafts. Fundamental techniques of plastic surgery and their surgical applications. Edinburgh: Churchill Livingstone; 2000. pp. 35–59.
Ebrahimi A, Ashayeri M, Rasouli HR. Comparison of Local Flaps and Skin Grafts to Repair Cheek Skin Defects. J Cutan Aesthet Surg. 2015 Apr-Jun;8(2):92–6.
Fernandes R. V to Y advancement flap. In: Local and Regional Flaps in Head and Neck Reconstruction : A Practical Approach. 1. izd. Wiley Blackwell; 2015. str. 50–6.
Omidi M, Granick MS. The versatile V-Y flap for facial reconstruction. Dermatol Surg. 2004 Mar;30(3):415–20.
Erçöçen AR, Can Z, Emiroğlu M, Tekdemir I. The V-Y island dorsal nasal flap for reconstruction of the nasal tip. Ann Plast Surg. 2002 Jan;48(1):75–82.
Chen WL, Wang YY, Zhou M, Yang ZH, Zhang DM. Double mental neurovascular V-Y island advancement flaps combined with tongue flaps for functionally reconstructing total lower-lip defects. J Craniofac Surg. 2012 Jan;23(1):181–3.
Quatrano NA, Stevenson ML, Sclafani AP, Carucci J. V-Y Advancement Flap for Defects of the Lid-Cheek Junction. Facial Plast Surg. 2017 Jun;33(3):329–33.
Chandawarkar RY, Cervino AL. Subunits of the cheek: an algorithm for the reconstruction of partial-thickness defects. Br J Plast Surg. 2003 Mar;56(2):135–9.
Pepper JP, Baker SR. Local flaps: cheek and lip reconstruction. JAMA Facial Plast Surg. 2013 Sep-Oct;15(5):374–82.
Ito O, Yano T, Kawazoe T, Suzuki S. Flexible Curved V-Y Subcutaneous Flap for Facial Skin Defects. Plast Reconstr Surg Glob Open [Internet]. 9. oktober 2015. [cited 30. avgust 2018.];3(10). Available from:
Pauchot J, Chambert J, Remache D, Elkhyat A, Jacquet E. Geometrical analysis of the V-Y advancement flap applied to a keystone flap. J Plast Reconstr Aesthet Surg. 2012 Aug;65(8):1087–95.
Wu G, Calamel PM, Shedd DP. THe hazards of injecting local anesthetic solutions with epinephrine into flaps: experimental study. Plast Reconstr Surg. 1978 Sep;62(3):396–403.
Juri J, Juri C. Advancement and rotation of a large cervicofacial flap for cheek repairs. Plast Reconstr Surg. 1979 Nov;64(5):692–6.
Fernandes R. Cervicofacial advancement flap. V: Local and Regional Flaps in Head and Neck Reconstruction : A Practical Approach. 1. izd. Wiley Blackwell; 2015. str. 92–102.
Kroll SS, Reece GP, Robb G, Black J. Deep-plane cervicofacial rotation-advancement flap for reconstruction of large cheek defects. Plast Reconstr Surg. 1994 Jul;94(1):88–93.
Patel UA, Bayles SW, Hayden RE. The submental flap: A modified technique for resident training. Laryngoscope. 2007 Jan;117(1):186–9.
Fernandes R. Submental island flap. V: Local and Regional Flaps in Head and Neck Reconstruction : A Practical Approach. 1. izd. Wiley Blackwell; 2015. str. 103–13.
Faltaous AA, Yetman RJ. The submental artery flap: an anatomic study. Plast Reconstr Surg. 1996 Jan;97(1):56–60.
Hanasono MM, Robb GL, Skoracki RJ, Peyrong Y. Local Flaps in Head and Neck Reconstruction: Submental Flap. V: Reconstructive Plastic Surgery of the Head and Neck: Current Techniques and Flap Atlas. New York:Thieme; 2016. str. 337–8.
Zdilla MJ. Exclusion of musculature from the submental flap: a contingency plan for facial nerve palsy. Plast Reconstr Surg Glob Open. 2015 Jan;2(12):e266.
Watanabe K, Shoja MM, Loukas M, Tubbs RS. Arteries of the Face and Neck. V: Anatomy for Plastic Surgery of the Face, Head and Neck. New York: Thieme; 2016. str. 47–62.
Higgins KM, Backstein R. The submental island flap: a regional and free flap with a myriad of reconstructive applications. J Otolaryngol. 2007 Apr;36(2):88–92.
Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C. in sod. Global, regional and national prevalence of overweight and obesity in children and adults 1980-2013: A systematic analysis. Lancet. 2014;384(9945):766–81.
Paučič J, Aničin A, Trček C, Grošelj A, Šifrer R, Pukl P. in sod. The Role of Regional Flaps in Head and Neck Reconstruction in the 21st Century. Med Razgl. 2016;55 Supplement 2:263–9.
Triana RJ Jr. Sir Harold Gillies. Arch Facial Plast Surg. 1999 Apr-Jun;1(2):142–3.
Smeele LE, Goldstein D, Tsai V, Gullane PJ, Neligan P, Brown DH, et al. Morbidity and cost differences between free flap reconstruction and pedicled flap reconstruction in oral and oropharyngeal cancer: matched control study. J Otolaryngol. 2006 Apr;35(2):102–7.
Forner D, Phillips T, Rigby M, Hart R, Taylor M, Trites J. Submental island flap reconstruction reduces cost in oral cancer reconstruction compared to radial forearm free flap reconstruction: a case series and cost analysis. J Otolaryngol Head Neck Surg. 2016 Feb;45(1):11.
Gunnarsson GL, Jackson IT, Thomsen JB. Freestyle facial perforator flaps-a safe reconstructive option for moderate-sized facial defects. Eur J Plast Surg. 2014;37(6):315–8.
How to Cite
Vozel D, Stritar A. Cheek reconstruction with VY, cervicofacial and submental flap. ZdravVestn [Internet]. 31May2019 [cited 17Sep.2019];88(3-4):143-55. Available from: