Reconstruction of large upper lip defects by free tissue transfer

Reconstruction of a large upper lip defect is a demanding procedure and can be performed by a variety of local flaps or by microvascular free tissue transfer. We present our experience in reconstructing near total or total upper lip defects by free tissue transfer. In 11-year period seven patients underwent microvascular reconstruction of upper lip, six with non-innervated radial forearm flap and one with non-innervated anterolateral thigh flap. In all patients good functional and acceptable aesthetic results, with oral competence at rest and during eating and speaking, were achieved. Deglutition and articulation were not affected in any patient. Sensory evaluation of reconstructed upper lips was performed in four patients and in three a reasonable recovery of sensation was recorded. In our opinion subtotal or total upper lip reconstructions with folded thin fascio-cutaneous free flaps produce very good functional and aesthetically acceptable results and avoid additional scars on lower lip and cheek. Further, because the size of the mouth is not altered, microstomia is avoided, which is especially important for patients using dentures. The remaining disadvantage of this method is non-competence of orbicularis oris muscle sphincter.