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Microsurgical Reconstruction of Extensive Lower Lip Defects: An Algorithm for Free Flap Selection and Functional
Luis Mata Ribeiro, Chi Peng1, David Chon-Fok Cheong2
1Departments of Medical Education.
Annals of Plastic Surgery
|April 19, 2023
Summary
Microsurgical reconstruction using free flaps offers safe and effective repair for extensive lower lip defects, significantly improving speech and feeding outcomes. Mandible resection negatively impacts feeding results.
Area of Science:
- Plastic Surgery
- Oral and Maxillofacial Surgery
- Microsurgery
Background:
- Large lower lip defects present significant reconstructive challenges.
- Limited local tissue necessitates advanced reconstructive techniques like free flaps.
Purpose of the Study:
- To report experience with microsurgical reconstruction of extensive lower lip defects.
- To introduce an algorithm for microsurgical technique selection.
- To assess functional outcomes post-reconstruction.
Main Methods:
- Retrospective review of 51 patients undergoing microsurgical lower lip reconstruction over 10 years.
- Functional outcomes assessed: speech, feeding, and oral continence.
- Patients stratified by mandible resection status (none, marginal, segmental).
Main Results:
- 96.1% of patients achieved intelligible speech.
- Only 1 patient experienced severe drooling.
- 72.5% of patients could consume solid or soft diets; mandible resection correlated with poorer feeding outcomes.
Conclusions:
- Microsurgical reconstruction of extensive lip defects is safe and yields good functional results.
- Free flap selection criteria include defect location, resected structures, and patient BMI.
- Feeding outcomes are inversely related to the extent of mandibular resection.
