Abstract
Total lower lip defects often require free flaps for reconstruction to achieve optimal outcome.
Here we present a case of a young woman who developed a severe mucormycosis of the lower lip during immunosuppression due to hemophagocytic syndrome. After debridement, the resulting defect included the whole lower lip and skin of the labiomental sulcus, in addition to part of the right upper lip eventually leading to drooling, altered speech, and a cosmetically severed lower face. Reconstruction was performed with a composite sensate free radial forearm flap for inner lining and skin coverage, including the palmaris longus tendon for suspension and lateral antebrachial cutaneous nerve coapted to the left mental nerve for sensation. The right upper lip vermilion was addressed using an advancement flap. After an uneventful postoperative course, secondary procedures included sculpture of the flap, scar correction, and tattooing for vermilion reconstruction achieving an excellent functional and cosmetic outcome by restoring lip sensation, appearance, and oral continence.
This is a preview of subscription content, log in via an institution to check access.
References
Akdemir O, Lineaweaver WC, Celik S, Cinar C, Zhang F. Submandibular artery: bilobed platysma myocutaneous flap for total lower lip reconstruction. J Craniomaxillofac Surg. 2014;42:1861–7. https://doi.org/10.1016/j.jcms.2014.07.004.
Chan RK, Bojovic B, Talbot SG, Weiss D, Pribaz JJ. Lower lip suspension using bilateral temporalis muscle flaps and fascia lata grafts. Plast Reconstr Surg. 2012;129:119–22. https://doi.org/10.1097/PRS.0b013e31823620b0.
Chen WL, Wang YY, Zhou M, Yang ZH, Zhang DM. Double mental neurovascular V-Y island advancement flaps combined with tongue flaps for functionally reconstructing total lower-lip defects. J Craniofac Surg. 2012;23:181–3. https://doi.org/10.1097/SCS.0b013e3182418ed5.
Chowchuen B. Modified bilateral neurovascular cheek flap: functional reconstruction of extensive lower lip defects. Plast Reconstr Surg Glob Open. 2016;4:e721. https://doi.org/10.1097/gox.0000000000000680.
Dediol E, Cvrljevic I, Dobranic M, Uglesic V. Extended Karapandzic flap technique for reconstruction of lower lip and chin defect. J Oral Maxillofac Surg. 2018;76:213–20. https://doi.org/10.1016/j.joms.2017.06.015.
Fang QG, Shi S, Zhang X, Li ZN, Liu FY, Sun CF. Total lower lip reconstruction with a double mental neurovascular V-Y island advancement flap. J Oral Maxillofac Surg. 2014;72:834.e831–836. https://doi.org/10.1016/j.joms.2013.12.010.
Gundeslioglu AO, et al. Lip reconstruction using a functioning serratus anterior free flap: preliminary study. Int J Oral Maxillofac Surg. 2017;46:1243–7. https://doi.org/10.1016/j.ijom.2017.04.026.
Gurunluoglu R, Glasgow M, Williams SA, Gurunluoglu A, Antrobus J, Eusterman V. Functional reconstruction of total lower lip defects using innervated gracilis flap in the setting of high-energy ballistic injury to the lower face: preliminary report. J Plast Reconstr Aesthet Surg. 2012;65:1335–42. https://doi.org/10.1016/j.bjps.2012.04.039.
Hekner DD, Abbink JH, van Es RJ, Rosenberg A, Koole R, Van Cann EM. Donor-site morbidity of the radial forearm free flap versus the ulnar forearm free flap. Plast Reconstr Surg. 2013;132:387–93. https://doi.org/10.1097/PRS.0b013e318295896c.
Jacobson L, Dedhia R, Kokot N, Chalian A. Scapular osteocutaneous free flap for total lower lip and mandible reconstruction. Microsurgery. 2016;36:480–4. https://doi.org/10.1002/micr.30040.
Jeng SF, Kuo YR, Wei FC, Su CY, Chien CY. Reconstruction of concomitant lip and cheek through-and-through defects with combined free flap and an advancement flap from the remaining lip. Plast Reconstr Surg. 2004a;113:491–8. https://doi.org/10.1097/01.Prs.0000100809.43453.C7.
Jeng SF, Kuo YR, Wei FC, Su CY, Chien CY. Total lower lip reconstruction with a composite radial forearm-palmaris longus tendon flap: a clinical series. Plast Reconstr Surg. 2004b;113:19–23. https://doi.org/10.1097/01.Prs.0000090722.16689.9a.
Jeng SF, Kuo YR, Wei FC, Su CY, Chien CY. Reconstruction of extensive composite mandibular defects with large lip involvement by using double free flaps and fascia lata grafts for oral sphincters. Plast Reconstr Surg. 2005;115:1830–6.
Keskin M, Sutcu M, Tosun Z, Savaci N. Reconstruction of total lower lip defects using radial forearm free flap with subsequent tongue flap. J Craniofac Surg. 2010;21:349–51. https://doi.org/10.1097/SCS.0b013e3181cf603a.
Lengele BG, Testelin S, Bayet B, Devauchelle B. Total lower lip functional reconstruction with a prefabricated gracilis muscle free flap. Int J Oral Maxillofac Surg. 2004;33:396–401. https://doi.org/10.1016/j.ijom.2003.11.004.
Lin YS, Liu WC, Lin YS, Chen LW, Hsueh JH, Yang KC. Double-paddle peroneal flap for extensive lip defect reconstruction. Microsurgery. 2017;37:558–63. https://doi.org/10.1002/micr.30136.
Muller-Richter UD, Weyandt GH, Woeckel A, Kubler AC. Vermilion reconstruction with genital mucosa. Plast Reconstr Surg Glob Open. 2016;4:e701. https://doi.org/10.1097/gox.0000000000000703.
Ninkovic M, Spanio di Spilimbergo S, Ninkovic M. Lower lip reconstruction: introduction of a new procedure using a functioning gracilis muscle free flap. Plast Reconstr Surg. 2007;119:1472–80. https://doi.org/10.1097/01.prs.0000258527.99140.fe.
Nthumba P, Carter L. Visor flap for total upper and lower lip reconstruction: a case report. J Med Case Rep. 2009;3:7312. https://doi.org/10.4076/1752-1947-3-7312.
Ozkan O, Ozkan O, Cinpolat A, Ubur MC, Bektas G, Jumshudov A, Uysal H. Functional lower lip reconstruction with the partial latissimus dorsi muscle free flap without nerve coaptation. Microsurgery. 2019;39:131–7. https://doi.org/10.1002/micr.30313.
Stathas T, Tsinias G, Tsiliboti D, Tsiros A, Mastronikolis N, Goumas P. Dorsalis Pedis free flap: the salvage option following failure of the radial forearm flap in total lower lip reconstruction. Case Rep Med. 2014;2014:458286. https://doi.org/10.1155/2014/458286.
Ueda K, Oba S, Ohtani K, Amano N, Fumiyama Y. Functional lower lip reconstruction with a forearm flap combined with a free gracilis muscle transfer. J Plast Reconstr Aesthet Surg. 2006;59:867–70. https://doi.org/10.1016/j.bjps.2005.10.014.
Yii NW, Niranjan NS. Fascial flaps based on perforators for reconstruction of defects in the distal forearm. Br J Plast Surg. 1999;52:534–40. https://doi.org/10.1054/bjps.1999.3170.
Yildirim S, Gideroglu K, Aydogdu E, Avci G, Akan M, Akoz T. Composite anterolateral thigh-fascia lata flap: a good alternative to radial forearm-palmaris longus flap for total lower lip reconstruction. Plast Reconstr Surg. 2006;117:2033–41. https://doi.org/10.1097/01.prs.0000210663.59939.02.
Yildirim S, Karaca M, Bilgic IM, Akoz T. Lower lip reconstruction with neck flaps as a salvage procedure. J Craniofac Surg. 2010;21:840–2. https://doi.org/10.1097/SCS.0b013e3181d87a12.
Author information
Authors and Affiliations
Corresponding author
Section Editor information
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this entry
Cite this entry
Schweizer, R., Rodriguez-Lorenzo, A. (2020). Total Lower Lip Reconstruction with Innervated Radial Forearm Flap and Palmaris Longus Tendon. In: Clinical Scenarios in Reconstructive Microsurgery. Springer, Cham. https://doi.org/10.1007/978-3-319-94191-2_15-1
Download citation
DOI: https://doi.org/10.1007/978-3-319-94191-2_15-1
Received:
Accepted:
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-94191-2
Online ISBN: 978-3-319-94191-2
eBook Packages: Springer Reference MedicineReference Module Medicine