Outcomes of Total or Near-Total Lip Reconstruction With Microvascular Tissue Transfer

Abstract

The reconstruction of total lower lip defects is very challenging, whether due to trauma or post-oncologic. The challenge faced by surgeons is to not only recreate an aesthetically pleasing lower lip but more importantly one that is functional. We reviewed our experience at the University of Florida College of Medicine Jacksonville, Division of Oral and Maxillofacial Surgery, in reconstructing these challenging defects over the past five years. Our time-line extended from 2007 to 2010. All surgeries were done by the senior author. The medical records were reviewed to retrieve demographics including: age, gender, reasons for the acquired defect, lip reconstructed, reconstructive method, flap survival, and outcomes. We identified 12 patients with a total of 13 free tissue transfers with total or near total lip defects reconstructed with free tissue transfer. The mean age was 57 years old with the overwhelming majority of the patients being male (10 vs 2). In 10 patients, the defects were due to resection of malignancies affecting the lip, while the remaining 2 patients were due to gunshot avulsive injuries. Of the 13 flaps used to reconstruct the defects, 11 were radial forearm flaps with the use of the palmaris longus tendon while one was the anterolateral thigh flap with the use of the fascia to resuspend the lip. There was a 100% survival rate of the flaps. Postoperatively all of the patients were able to take oral diet and none of the patients complained of drooling, inability to eat in a public setting, or microstomia. Of the patients reconstructed, 8 received either pre- or postoperative radiation therapy while the remaining 4 patients did not. In our case series, the radial forearm free flap was the most commonly used flap for lip reconstruction. The use of free tissue transfer for lip reconstruction is a very predictable method for reconstructing these challenging defects, while maintaining the patient's ability to take in an oral diet. While there was a clear color mismatch in most of the patients, none viewed this as a major drawback of the reconstruction.