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Bone Remodeling and Repair

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Osteoclasts are cells responsible for bone resorption and remodeling. They originate from hematopoietic progenitor cells present in the bone marrow. Numerous progenitor cells fuse to form multinucleated cells, each with 10-20 nuclei. A single osteoclast has a diameter of 150 to 200 µM. These cells have ruffled borders that break down the underlying bone tissue and release minerals such as calcium into the blood in bone resorption. Osteoclasts cling to bones with their ruffled edges during bone...

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Updated: May 8, 2026

In situ Transverse Rectus Abdominis Myocutaneous Flap: A Rat Model of Myocutaneous Ischemia Reperfusion Injury

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Complex Salvage Lower Lip Reconstruction Using Gracilis Free Flap.

Alexandra Welschmeyer^1,2, Daniel Karasik^1,2, Humzah Quereshy^1,2

¹School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.

Facial Plastic Surgery & Aesthetic Medicine

|March 24, 2025

Summary

This summary is machine-generated.

The gracilis free flap offers a viable solution for salvage lower lip reconstruction in patients with complex defects, even after prior free flap failures. This technique can restore both function and aesthetics with minimal donor site morbidity.

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Area of Science:

Microsurgery
Plastic Surgery
Reconstructive Surgery

Background:

Gracilis muscle microneurovascular free tissue transfer is a standard for dynamic facial reanimation.
It is a reconstructive option for large lower lip defects, especially after prior free flap failure or inadequate local tissue availability.

Purpose of the Study:

To define the use of gracilis muscle free flap for salvage lip reconstruction.
To evaluate its efficacy in patients with persistent lower lip defects after previous reconstructions.

Main Methods:

Chart review of four patients with total lower lip defects and prior free flap reconstruction.
Surgical technique involved gracilis free flap for salvage lip reconstruction.
Nerve coaptation included obturator to hypoglossal (end-to-side) and distal facial/masseter (end-to-end).

Main Results:

Four patients (3 male, ages 55-70) with prior free flap reconstruction underwent salvage lip repair.
Initial defects were due to cancer (3) and necrotizing fasciitis (1).
The gracilis free flap successfully addressed persistent lower lip defects.

Conclusions:

The gracilis free flap is a suitable option for salvage lip reconstruction in complex cases.
It can improve both lower lip function and aesthetics.
The procedure is associated with minimal donor site morbidity.