Total Lower Lip Reconstruction Using Sensate Composite Radial Forearm Flap

Abstract

In modern plastic and reconstructive surgery, shape and function must be considered together. These are the most important goals of any operation. There are a lot of techniques that have been reported for total lower lip reconstruction. It is believed that the radial forearm flap is the most suitable technique for lower lip and chin reconstruction after tumor excision so as to achieve better shape and functional results. The sensate radial forearm-palmaris longus free flap was used for total lower lip reconstruction in 17 patients with lower lip carcinoma with a mean age of 51 years. Two of the patients were female, and 15 were male. All the patients had squamous cell carcinoma. The patients were followed up for 1 to 3 years. Complications of these operations were partial superficial flap loss in 1 patient, partial graft loss in the donor areas of two flaps, and infection in only 1 patient. Wound dehiscence, fistula formation, suture abscesses, or sialocele was not seen in any patient. In this study, the aim was to demonstrate that the sensate radial forearm flap could produce acceptable esthetic results, good sphincteric function, and sensation in the early period after surgery.

The Use of Radial Forearm Free Flap for Total Lower Lip Reconstruction:The Analysis of 10 Consequentive Cases and Quality of Life Evaluation

“…Our experiences show that this technique of tendon fixation is able to restore complete circumference of oral sphincter. Moreover, this variant of dynamic reconstruction is an easy, one stage procedure providing similar functional outcome comparing to cases where the tendon was sutured to zygomatic arches [4][5][6]. In our limited data the results show only the idea of different radial flap modalities influencing the quality of life outcome and therefore it is presented as preliminary report.…”

“…This particular free flap is highly reliable because of large diameter of its artery and veins. The vascular pedicle is ideal with long vessels capable to reach the opposite side of the neck if necessary [5]. That characteristic makes it a useful one for lower face postresection defects reconstruction.…”

The Karapandzic Flap in Lower Lip Reconstruction

“…The most frequently used free flap is the radial artery forearm free flap, with palmaris tendon suspension for lower lip loss [22]. The flap can be innervated by anastomosing a branch of the lateral antebrachial cutaneous nerve to the transected end of the inferior alveolar nerve; however, the usefulness of this maneuver is debatable because thin flaps such as the radial forearm flap often spontaneously regain some sensation without any nerve coaptation [23].…”

Total lower lip functional reconstruction with a prefabricated gracilis muscle free flap

“…The use of a radial forearm free flap including the palmaris longus tendon as a static support for a new two layered labial unit represents an alternative choice 6,24,32 . However, even if the flap may become sensate 22 and partly linked to the neighboring mimic or masticatory muscles 20,26 , the lip reconstructed in this way lacks dynamic motility in facial expression and, due to a bad color match with the surrounding skin, gives a poor and bulky aesthetic appearance to the lower face.…”

“…The lip is a complex anatomical structure which includes a muscular layer which is part of the oral sphincter, lying between a mucosal layer and the overlying skin. In order to restore the three layers, several reconstructive procedures have been described including local flaps harvested from the cheeks 12,17,19,31 , pedicled flaps elevated from the forehead 21 , expanded cervical or jugal skin flaps 11,23 and finally, fasciocutaneous free transfers 6,7,22,24,25,32 . Nevertheless, none of them brings an ideal solution regarding appearance and function.…”