Restoring Lower Lip Competence After Fibula Free Flap Mandibular Reconstruction: A Stage 2 Salvage Procedure

Composite mandibulo-labial defects require restoration of mandibular continuity and oral competence. Stage 1 fibula free flap reconstruction restores bone and provides lining and cover, but oral competence depends on reestablishing orbicularis oris continuity. After stage 1, patients may continue to experience drooling, poor lip seal, and an obliterated gingivolabial sulcus due to scar tethering and muscle discontinuity. We describe a stage 2 salvage procedure, which includes release of vestibular scar bands, limited mobilization of the healed fibula free flap skin paddle for sulcus lining, and direct reapproximation of orbicularis oris stumps (figure-of-eight 3-0 poly-p-dioxanone). In a pediatric ballistic injury, lip seal improved; after rehabilitation, no visible drooling was observed during conversation, although active excursion remained limited.