Preoperative Imaging Review Predicts the Complex Venous Anatomy of the Submental Island Flap

Objectives: The submental island flap is a dependable option for head and neck reconstruction. Venous drainage depends on the submental vein, which typically drains into the facial vein and, subsequently, the internal jugular vein. Variations in venous anatomy often involve drainage into the anterior jugular or external jugular venous systems. This study evaluates the likelihood of encountering submental venous anatomy variants and the accuracy of preoperative imaging in identifying them. Methods: Twenty-two patients who underwent a submental island flap procedure at the University of New Mexico Hospital from 2015 through 2023 with defined submental venous anatomy were analyzed. Three surgeons, blinded to intraoperative findings, predicted venous anatomy from preoperative imaging, with inter-rater reliability assessed using Fleiss Kappa. Results: Fifteen patients exhibited typical venous anatomy. Four patients’ submental venous vasculature showed drainage into the external jugular vein, and 3 into the anterior jugular vein. Imaging reviews showed accuracy rates of 72.23%, 90.91%, and 86.36%, respectively. Analysis of cases with CT scans yielded k = 0.46 ( P  < .001). Conclusion: The submental island flap is versatile and reliable but demonstrates common variant venous anatomy. Accurate imaging-based predictions can optimize surgical efficiency and outcomes.