FUNCTIONAL RECONSTRUCTION OF SOFT TISSUE OROFACIAL DEFECTS WITH MICROVASCULAR GRACILIS MUSCLE FLAP

Free flap reconstructive surgery of middle size and large oral and facial defects enables aesthetic and functional rehabilitation. Microvascular flap reconstructive surgery, with flap survival success rate more than 90-98%, is a gold standard in head and neck extensive reconstructions. Currently, head and neck reconstructive surgery is focused not only on defect occlusion and adequate aesthetical result, but the same emphasize is aimed at functional result. Functional result post tongue and lip resection means defect occlusion with the possibility of movement restoration. Free gracilis muscle flap appears to be a choice for functional tongue and lip reconstruction.

We present 1-year experience with 5 microvascular flap functional reconstructions of middle size and large defects of tongue and lip with free gracilis muscle flap. Four patients post tongue resection and one post subtotal lower lip and cheek resection underwent immediate functional microvascular gracilis muscle flap reconstruction.

All five patients were successfully reconstructed with functional free gracilis muscle flap, with no flap loss. We found gracilis muscle flap harvest is not technically demanding, provides adequate tissue volume for middle size orofacial defects reconstruction, with possibility for skin island harvest, and simple primary closure of donor site with very low morbidity. Patients after tongue reconstruction with free gracilis flap were swallowing spoon ood 1 week post operation. Patient after total lip resection and immediate reconstruction with free gracilis flap presented with oral competence before the discharge. The functional result in the group of patients with free gracilis flap reconstruction for orofacial defect will have to be further evaluated again after 2 years post operation considering the ability to swallow and articulate during the speech for the tongue reconstructions and the oral competence and facial mimic for the lip reconstruction.

Microvascular gracilis muscle flap reconstruction compared to radial forearm flap reconstruction enables functional reconstruction of soft tissue defect. Functional reconstruction of soft tissue defects of tongue or lip with microvascular gracilis muscle flap appears to have advantage of adequate volume, very low donor side morbidity and expectancy of movement renewal compared to other microvascular flap reconstructive options such as anterolateral thigh flap, superficial circumflex iliac artery perforator flap, lateral arm free flap or deep inferior epigastric perforator free flap.