Reconstruction of lower lip defects with free super-thin anterolateral thigh flap

Lower lip is a vital organ with important functions as well as aesthetic importance. It is critical to provide an aesthetically appealing lower facial subunit with maintenance of understandable speech and oral competence. Achieving these targets is very difficult especially in total lower lip defects. This report presents a technique using super-thin anterolateral thigh (ALT) flaps with fascia graft for reconstruction of large, complex oral sphincter defects.

Six patients with squamous cell carcinoma (SCC) and one patient with a gunshot injury were presented in this report. All of them had full-thickness defects including skin, orbicularis muscle and oral mucosa. The mean age was 58 (range, 32-85) years. Defects of the lower lip were reconstructed with a super-thin ALT flap. Super-thin flaps were obtained by planning as close to the knee as possible and elevating at the level of superficial fascia. The fascia graft was used for achieving lip suspension.

Overall flap survival was 100%. The flap size ranged from 8 × 6 cm to 14 × 10 cm. The follow-up periods ranged from 6 to 14 months. All the patients achieved acceptable oral competence, both in the resting condition and during speaking and eating, except for one patient who had a drooping lower lip developed in the post-operative 3rd month and underwent a secondary tightening procedure. Another patient needed liposuction due to bulky appearance.

Super-thin ALT flaps seem to be a useful option for functional and aesthetic reconstruction of extensive lip defects.