Lower Lip Reconstruction With the New Ascending Mental Artery Perforator Flap

Full-thickness defects of the lower lip pose a considerable challenge for reconstructive surgeons. The primary objective should be the restoration of oral sphincter competence, achieving both functionally and aesthetically favorable outcomes. For defects involving more than one-third of the lower lip, multiple locoregional flaps have been described as the optimal solution due to their color and texture match. Unfortunately, complications such as reduction of buccal circumference or microstomia have been reported, impacting patients' quality of life. For defects exceeding 80% of the lower lip, free flaps are required. In this study, we propose the new ascending mental artery perforator flap, based on the superficial perforating branches of the ascending mental artery. We applied this technique to 11 patients undergoing lower lip cancer excisions with defects involving 30%-70%. Our primary objective was to maintain oral continence, avoiding reduction of mouth circumference or various grades of buccal microstomia. All patients were satisfied with the functional and aesthetic final outcomes checked by long-term follow-up through clinical examination and photographs/videos (from 14 to 50 mo, with an average follow-up of 26.2 mo). This surgical procedure allows us to raise a safe and easy-to-harvest locoregional flap within a relatively short operative time, bringing a great amount of similar tissue to what is required for reconstruction. Finally, the AMAP flap has been demonstrated to fulfill the main goals of lower lip reconstruction, avoiding the most frequent complications described in the literature, especially the reduction of the circumference of the mouth.