*4.1.2.1 The submental pediculate flap*

The submental pediculate flap is vascularized by the submental artery, a branch of facial artery. It must include a segment of the anterior belly of digastric to perfuse the overlying skin through perforants. The amount of tissue available to harvest depends on the pitching test that predicts the possibility of primary closure of the donor site. This flap entails to avoid sacrifice of its vascular pedicle so the clue is that it should be planned and harvested at the beginning of neck dissection [5] (**Figure 2a**–**c**). Sometimes nodal disease levels Ia and Ib limit the ability to harvest the submental flap without impairing the oncological resection. The main advantage of this flap is the proximity between the donor site and the floor of the mouth so it can be insetted easily; the main problem is that if it is harvested with a big amount of muscle, the result once insetted may be a bulky flap resulting on swallowing and speaking problems.
