Total Lower Lip Reconstruction Using Free Neurotendinofasciocutaneous Anterolateral Thigh Composite Flap: A Case Report

Tan, Önder; Kuduban, Selma Denktas; Algan, Said; Çinal, Hakan; Barin, Ensar Zafer

doi:10.1055/s-0033-1343833

Cited by 13 publications

(8 citation statements)

References 6 publications

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“…The ALT flap is an alternative option for lip reconstruction with the advantages of a 2-team approach, large skin paddle, chimeric and composite flap design, long and caliber vascular pedicle, inconspicuous donor-site scar, and sensate planning. 8,10,[33][34][35][36] However, variations in the vascular perforators of the skin paddle, 8,35,36 bulky skin paddle, 8,14,36 hairy vestibular lining in hirsute patient, 8 and color mismatch 8,36 are disadvantages of lip reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of Multiple Lip and Facial Defects With Bipaddle and Sensate Radial Forearm Free Flap

Evin,

Selimoglu

2024

Ann Plast Surg

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Free flaps and their modifications are used to reconstruct multiple large defects in the lip and face. In this study, we present our results on the reconstruction of these defects using bipaddle and sensate free radial forearm-palmaris longus flaps and subsequent revision surgeries. Patient medical records of 11 patients with a mean age of 63.9 ± 12.8 years were retrospectively reviewed. Functional oral competence, lip cosmetics, lip sensation, and donor forearm scars were evaluated using the drooling rating scale, visual analog scale, Semmes Weinstein Monofilament test, and patient and observer scar assessment scale, respectively. The mean dimensions of distal and proximal skin paddles of bipaddle free radial forearm-palmaris longus flaps were 12.7 ± 9.9 and 20.5 ± 3.8 cm2. Mean lengths of the bridge and proximal pedicles were 4.7 ± 1.6 and 5.5 ± 0.7 cm. All the flaps survived. No drooling was observed in the 2 patients without lower lip defects. The mean drooling scores of the 9 patients with lower lip defects were statistically different (Analysis of Variance, pANOVA < 0.00001) at 3, 6, 9, and 12 months postoperatively. The differences between 3 and 12 months were the most significant (pANOVA < 0.00001, pTUKEY < 0.000001). The lip sensation and drooling scores showed a strong positive correlation (r = 0.8504). All patients were able to speak fluently, drink fluid without leakage, and blow a balloon easily. All patients and observers were satisfied with the lip cosmetics, with no significant difference between satisfaction scores (P = 0.087615). There was a statistically significant difference (P < 0.00001) between mean sensation scores of surrounding healthy lip (2.94 ± 0.27) and free flaps (4.15 ± 0.4). All the donor scars healed uneventfully.

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Section: Discussionmentioning

confidence: 99%

Reconstruction of Multiple Lip and Facial Defects With Bipaddle and Sensate Radial Forearm Free Flap

Evin,

Selimoglu

2024

Ann Plast Surg

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“…Methods for oral reconstruction by improving free flaps have been reported. Chien and Onder used the ALT flap for the reconstruction of lip defects [ 14 , 15 ]. Reconstruction of midface defects through RFFF was described by Wei [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of a subtotal upper lip defect with a facial artery musculomucosal flap, kite flap, and radial forearm free flap: a case report

Wang

Zhang

et al. 2018

World J Surg Onc

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BackgroundFor reconstructive surgeons, massive midface defects, including large, full-thickness wounds on the upper lip, can be very challenging. Although there are many methods for reconstruction of upper lip defects, it is difficult to obtain satisfactory restoration of oral functions and good cosmetic results.Case presentationThis case report presents a man with massive midface defects, including upper lip, left nose, and cheek defects. Over the previous 2 years, the patient had three reconstructions with sequential free flaps for the resection of recurrent tumors, the first of which was in March of 2016; this resulted in the patient having massive midface defects, including an upper lip defect, a defect on the left side of the nose, and one on the left cheek. The defects were reconstructed using a radial forearm free flap (RFFF), a facial artery musculomucosal (FAMM) flap, and a kite flap. In June 2016, he underwent a second reconstruction, this time of the left nose defect, using a left anterolateral thigh (ALT) flap. In March of 2017, the patient underwent a third reconstruction with the use of a free ALT on the left intraoral cheek and the defects on the neck. All flaps survived. No complications were encountered postoperatively. The patient regained good oral sphincter function with no reports of drooling. Although the patient underwent three surgeries, the reconstruction results were acceptable.ConclusionsFor massive midface defects, including large, full-thickness wounds on the upper lip, the combination of a FAMM flap, kite flap, and RFFF promotes the reconstruction of the complex midface structure and improves the resulting functionality.

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“…This flap is very versatile and can be trimmed and defatted to suit any type of defect. 5,[10][11][12] The FL can be used as an anchoring structure, similar to the PL tendon previously described. If this flap is not available, the second option is the PAP flap.…”

Section: Table 5 Algorithm For Extensive Lower Lip Defect Reconstructionmentioning

confidence: 99%

“…Several other techniques have also been reported for lower lip reconstruction. Composite anterolateral thigh (ALT) free flap and FL offer a good alternative, significantly reducing donor site morbidity 10–12 . Various authors have reported successful functional outcomes using free functioning muscle transfers 13–15 .…”

mentioning

confidence: 99%

“…Composite anterolateral thigh (ALT) free flap and FL offer a good alternative, significantly reducing donor site morbidity. [10][11][12] Various authors have reported successful functional outcomes using free functioning muscle transfers. [13][14][15] In cases of combined lower lip-mandible defects, some authors advocate the use of a double free flap transfer, 16,17 whereas others use free fibula 18 or scapular flaps 19 with extended skin paddles.…”

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confidence: 99%

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Microsurgical Reconstruction of Extensive Lower Lip Defects

Ribeiro

Peng²,

Cheong

et al. 2023

Ann Plast Surg

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Background: Large defects of the lower lip pose a difficult challenge for any reconstructive surgeon. When there is limited local tissue available to resurface the defects, free flaps are the preferred option. Aim and Objectives: We reported our experience in the reconstruction of extensive lower lip defects. The authors propose a new algorithm for microsurgical technique selection and assessment of the functional outcomes obtained. Materials and Methods: A retrospective review of all microsurgical reconstructions of extensive lower lip defects by the senior author for 10 years was performed. The functional outcomes assessed included speech, feeding, and oral continence. Patients were stratified according to their status of simultaneous mandible resection (none, marginal, segmental).Results: Fifty-one patients were included in this study. Almost all patients (96.1%) achieved intelligible speech. Only 1 patient experienced severe drooling. Most patients could eat a solid or soft diet (72.5%). Mandible resection was associated with the worst feeding outcomes.Conclusions: Microsurgical reconstruction of extensive lip defects is safe and provides good results. Free flap selection should take into account the location of the defect, the resected structures, and the body mass index of the patient. Feeding status seems to be inversely correlated with the amount of mandibular resection.

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Total Lower Lip Reconstruction Using Free Neurotendinofasciocutaneous Anterolateral Thigh Composite Flap: A Case Report

Cited by 13 publications

References 6 publications

Reconstruction of Multiple Lip and Facial Defects With Bipaddle and Sensate Radial Forearm Free Flap

Reconstruction of Multiple Lip and Facial Defects With Bipaddle and Sensate Radial Forearm Free Flap

Reconstruction of a subtotal upper lip defect with a facial artery musculomucosal flap, kite flap, and radial forearm free flap: a case report

Microsurgical Reconstruction of Extensive Lower Lip Defects

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