The Use of Vastus Lateralis Muscle Flap for Functional Lip Reconstruction

Abstract

Background: Total or near-total lip defects poses a serious challenge to a reconstructive surgeon with static procedures not providing desired functional and aesthetic outcomes. The dynamic lip reconstructive methods using functional muscles have become a current issue in recent years showing admirable results. This study present 3 cases of successful total and near-total lip reconstruction are presented using vastus lateralis muscle. Methods: This is a retrospective analysis of a consecutive series of 3 patients (2 men and 1 woman) aged 44 to 56 years (mean) who had resection of extensive squamous cell carcinoma 2 had both upper and lower lip involved and 1 had lower lip involvement only. After resection patients had near total full thickness lower lip defect and 40% upper lip defect. The innervated vastus lateralis muscle free flap was transferred to the lip and end-to-end vascular anastomosis on the facial artery and end-to-side to internal jaguar vein was performed. The marginal mandibular branch of the facial nerve was used for nerve coaptation. The inner and outer surfaces of the flaps were grafted with a thick-split-thickness skin graft. Drooling rating scale and patient and observer scar assessment scale as well as electromyography were performed to evaluate oral competency and aesthetic outcome. Results: All patients underwent single stage near-total lower lip and 2 had part of upper lip reconstruction successfully and survived the surgical operation. One patient lost the skin graft and was managed consecutively and muscle granulated and healed. Two patients underwent radiation therapy and 1 died before starting radiation due to other unnatural causes. The 2 patients achieved perfect oral sphincter competence without drooling and at 9months postoperative demonstrated successful reinnervation of the vastus lateralis muscle. Conclusions: This study demonstrates that lip reconstruction using an innervated vastus lateralis muscle free flap is a reliable method, providing a functional lip

Free Flap Reconstruction of the Lower Lip: A Systematic Review and Meta-Analysis

“…Two other articles reported the Patient and Observer Scar Assessment Scale to judge the aesthetic outcome of the reconstructed lip following RAFF surgery. 24,25 Forty-six articles 4,6-9,20,21,23,25-62 described 200 patients who had fasciocutaneous free flap reconstruction of the lower lip. Within these, 33 articles described 119 patients with static slings and 13 articles described 81 patients with no sling.…”

“…Two other articles reported the Patient and Observer Scar Assessment Scale to judge the aesthetic outcome of the reconstructed lip following RAFF surgery. 24 25…”

“…Thirteen articles 10 11 12 24 63 64 65 66 67 68 69 70 71 described 42 patients reconstructed with muscular free flaps to repair lower lip defects. The gracilis was the most used muscular free flap and was innervated in all cases ( n = 20, 8 articles).…”

Total lower lip reconstruction: a review of recent advances

“…Recently, Lelala and colleagues have described using an innervated vastus lateralis muscle free flap for complex lower lip reconstruction in three patients [50 ▪ ]. Only a small segment of the muscle is harvested, minimizing donor site morbidity.…”