Traction-assisted dermatogenesis is an additional method of tissue expansion that is easy and cost effective for reconstruction.

Lip reconstruction is best suited to the dictum of replacement of like tissue with like. The use of the remaining lip in the use of the lip reconstruction becomes more difficult as the size of the defect increases. The use of local tissue for subtotal lower lip loss problems like microstomia and facial and commissure distortion are real risks. The use of free tissue transfer becomes especially an attractive option when in addition to the lip there is associated loss of other aesthetic units and/or mandibular bone loss. The potential value of local perioral tissue is more likely to maintain dynamic and sensory function of the lip.Five patients were included in the clinical series during a period of 3 1/2 years since January 2002. All 5 patients were men. The age ranged from 15 to 67 years. Four patients underwent reconstruction by composite radial forearm flaps including both the cutaneous nerve of the forearm and the palmaris longus tendon. A single patient in this group had a partial brachioradialis muscle flap raised as chimeric component to the composite radial forearm flap. In the fifth patient, 2 simultaneous free radial forearm flaps were used for both upper and lower lip and bilateral buccal mucosal reconstruction. All patients achieved the goals of providing an adequate mouth opening with competence. The refinement of dynamic palmaris sling attachment to the perioral muscle provided for very good oral competence and support. In the single patient, adding bulk with the brachioradialis muscle to the neo lower lip most likely served to improve both aesthetics and lip function. With the use of free flaps an adequate labial sulcus, near dynamic sphincter control and sensation can be restored. The major drawback, however, is aesthetics of the lip. Further refinements like vermillion tattooing, fat injections or defatting by liposuction, and secondary mucosal flap surgery to provide the neolip with a vermillion are beneficial.

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The fibula osteoseptocutaneous flap has undergone multiple refinements since its first description in oromandibular reconstruction. There is now a better understanding of the blood supply to the skin of the lateral aspect of the leg. Multiple free skin paddles can be harvested freestyle from the lateral aspect of the leg. The size of the flaps that can be harvested has not been clearly defined. A case report of a complex oromandibular reconstruction following a shotgun injury to the face demonstrates a way of maximizing the skin harvest. An osteoseptocutaneous fibula flap was used for the replacement of the mandible and the internal lining of the oral cavity. A larger lateral leg flap based on a musculocutaneous perforator of the peroneal artery was used for the external and full-thickness lower-lip defect. The latter flap by definition is a peroneal artery perforator flap, which to the best of my knowledge is terminology that has not been used in the English literature. The main purpose of this article is to review the blood supply of the lateral leg and how this can be utilized to reach the goals of a complex oromandibular and total lower-lip reconstruction.