Total Lower Lip Reconstruction: Clinical Series

Full–thickness defects of the lower lip and commisure continue to present a challenge to the reconstructive surgeon. To achieve both a functional and aesthetically pleasing result in a single–stage operation is the ideal. The authors presented the use of both the radial forearm free flap and the osseocutaneous fibula flap for reconstruction of total lower lip and commissure defects.

Six patients were recruited to the study, five following ablative cancer surgery and one following debridement of cancrum oris lesions. Surgical resections included various combinations of lower lip, commissures, cheek and buccal defects. Single–stage operations were performed in all but one patient. A single patient had a fibular osseocutaneous free flap harvested to replace lining, mandible, and skin of the lower lip and left buccal tissue. Five patients had radial forearm flaps. One patient from this group had the brachioradialis muscle included in a chimeric flap to add bulk to the lower lip. In five patients, the palmaris longus tendon was used to reconstruct the oral sphincter. The skin was used to provide both lining and external cover, creating an adequate alveolar sulcus. Sensory restoration was performed in four patients.

Free flap survival was 100%. Follow–up ranged between 6 months and 3 years. Immediate complications included one patient with sepsis requiring debridement. Two patients with fistulas were treated conservatively and recovered well. Oral competence was achieved in five patients. The patient that had flap sepsis had less than a satisfactory cosmetic and functional result. Tumor recurrence occurred in a single patient. Aesthetic results gained were acceptable to both patients and surgeons.

The use of local flaps is generally accepted as the mainstay for total lower lip reconstruction. It provides sensate, dynamic, local, and like tissue. But it may fall short in providing adequate oral aperture, commissure, and upper lip aesthetics. Free flap surgery offers an excellent option for reconstruction of full–thickness lower lip, commissure, and buccal defects to achieve the aims of both functionality and cosmesis.