Total lower lip reconstruction with a composite radial forearm- XXXX flap: a clinical series.

@entity1 @entity3306 @entity5 @entity924 @entity5815
Large, full-thickness @entity3306 after head and neck surgery continue to be a challenge for reconstructive surgeons. The reconstructive aims are to restore the oral lining, the external cheek, oral competence, and function (i.e., articulation, speech, and mastication). The authors' refinement of the composite radial forearm-palmaris @entity5815 technique meets these criteria and allows a functional reconstruction of extensive lip and cheek defects in one stage. A composite radial forearm flap including the @entity924 was designed. The skin flap for the reconstruction of the intraoral lining and the skin defect was folded over the @entity924 . Both ends of the vascularized tendon were laid through the bilateral modiolus and anchored with adequate tension to the intact orbicularis muscle of the upper lip. This procedure was used in 12 @entity1 . Six @entity1 had @entity5 of the lower lip, five @entity1 had a buccal @entity5 involving the lip, and one @entity1 had a primary gum @entity5 that extended to the lower lip. Total to near-total resection (more than 80 percent) of the lower lip was indicated in six @entity1 . In two other @entity1 , the @entity5 ablation included more than 80 percent of the lower lip and up to 40 percent of the upper lip. A radial forearm palmaris @entity5815 was used in all cases for reconstruction of the defect. Free flap survival was 100 percent. At the time of final evaluation, which was 1 year after the operation, all @entity1 had good oral continence at rest (static suspension) and had achieved sufficient oral competence when eating. Ten @entity1 were able to resume a regular diet, and two @entity1 could eat a soft diet. All @entity1 regained normal or near-normal speech and had an acceptable appearance. The described refinement of the composite radial palmaris @entity5815 technique allows the reconstruction of the lower lip with a functioning oral sphincter; the technique can be recommended for @entity1 who need large lower lip resection. It provides functional recovery of the reconstructed lower lip synchronizing with the remaining upper lip.
