Outcomes of total or near-total lip reconstruction with microvascular tissue transfer

The reconstruction of total lower lip defects is very challenging, whether from trauma or after oncologic treatment. The challenge faced by surgeons is to re-create not only an esthetically pleasing lower lip but also, more importantly, a lip that is functional.

The authors reviewed their experience at the Division of Oral and Maxillofacial Surgery, University of Florida College of Medicine, Jacksonville in reconstructing these challenging defects over a 3 year period. The timeline extended from 2007 through 2010. All surgeries were performed by the senior author. The medical records were reviewed to retrieve demographics, including age, gender, reasons for the acquired defect, lip reconstructed, reconstructive method, flap survival, and outcomes.

Twelve patients with 13 free tissue transfers for total or near total lip defects reconstructed with free tissue transfer were identified. The patients' mean age was 57 years, and the overwhelming majority of patients were men (10 vs 2). The defects were due to resection of malignancies affecting the lip in 10 patients and to avulsive gunshot injuries in 2 patients. Of the 13 flaps used to reconstruct the defects, 11 were radial forearm flaps using the palmaris longus tendon and 1 was an anterolateral thigh flap using the fascia to resuspend the lip. There was a 100% survival rate of the flaps. Postoperatively, all patients were able to take oral diet and none of the patients complained of drooling, an inability to eat in a public setting, or microstomia. Of the patients who underwent reconstruction, 8 received pre- or postoperative radiation therapy and the remaining 4 patients did not.

In this case series, the radial forearm free flap was the most commonly used flap for lip reconstruction. The use of free tissue transfer for lip reconstruction is a very predictable method for reconstructing these challenging defects and maintaining a patient's ability to take in an oral diet. Although there was a clear color mismatch in most patients, none viewed this as a major drawback of the reconstruction.