Transverse fascial suspension with muscle bow traction: Advantages for full-thickness lip reconstruction involving the oral commissure using free flap

Abstract

SummaryLarge full-thickness oral defects involving the oral commissure continue to be a challenge for reconstructive surgeons.Although local flaps are the best option for full-thickness lip reconstruction, they are unavailable for large defects. In particular, recent advances in microsurgery have extended the available surgical options using free flaps, but for full-thickness large oral defects involving the oral commissure, it is still difficult to obtain good function and competence. The major disadvantages are the drooping and loosening of the reconstructed lip and the difficulty in restoring a natural oral commissure.We present 2 cases of lip reconstruction for full-thickness large defects involving the oral commissure in which free flaps with the muscle bow traction method were used to overcome these problems.In case 1, the lip was reconstructed with a free radial forearm-palmaris longus tendon composite flap. The tendon was sutured onto the orbicularis oris stumps.In case 2, the lip was reconstructed with a free anterolateral thigh flap including the fascia lata. A fascial strip in the flap was sutured to the residual orbicularis muscles. In each case, additional nonvascularized fascia lata was harvested 3 and suspended the reconstructed lip in transverse direction as a muscle bow traction method. Both patients achieved good oral competence without medial deviation of the oral commissure and were able to resume a regular diet without drooping and loosening of the reconstructed lip.For large full-thickness oral defects involving the oral commissure, transverse fascial suspension with muscle bow traction is useful for functional and cosmetic reconstruction.

Composite pronator quadratus: radial forearm free flap in functional lip reconstruction

“…Poor oral competence particularly during dynamic activities is a common complication . In addition, the reconstructed lip often droops and loosens over time secondary to loss of orbicularis oris function …”

“…Despite some positive reports, the reconstructed lip with this technique is still viewed by some as immobile and insensate . Some authors have attempted more elegant techniques such as local muscle transfer combined with free flap reconstruction .…”

“…Of these options, suturing to the modiolous bilaterally has proven the most effective technique. 5,8,11,12,15,[17][18][19][20][21] The evolution of these suspension techniques has improved the functional and aesthetic outcomes of the PL sling in general. Other authors have also combined the PL sling with local muscle transfer, such as temporalis, masseter or depressor anguli oris, for a more dynamic reconstruction.…”

“…8,9,17 In addition, the reconstructed lip often droops and loosens over time secondary to loss of orbicularis oris function. 17,20,[22][23][24][25] Despite some positive reports, the reconstructed lip with this technique is still viewed by some as immobile and insensate. 9,20 Some authors have attempted more elegant techniques such as local muscle transfer combined with free flap reconstruction.…”

One-stage through-and-through cheek, lips, and oral commissure reconstruction using a double-paddle peroneal chimeric flap: An innovative method

“…A 1‐piece flap folded into the oral commissure is usually used to restore through‐and‐through cheek defects involving the oral commissure and lips. A suspension techniques, either static or dynamic, combined with 1‐piece flap reconstruction has been introduced to create better lips and oral commissure with a one‐stage operation . Unfortunately, a rounded oral commissure and unnatural commissure position still lead to drooling and oral incompetence that require additional revision.…”