Composite pronator quadratus: radial forearm free flap in functional lip reconstruction

Abstract

Background Reconstruction of lip defects following neoplasia and trauma is a common procedure in plastic surgery. Reconstruction of large lip defects is a difficult undertaking and some degree of residual functional impairment and disability are likely to occur. Microsurgical reconstruction is the recommended technique for large lip defects; however, limitations exist regarding optimal aesthetic and functional outcomes with current free flap options. Method We propose a new composite flap design based on the innervated pronator quadratus with the radial forearm free flap for a more dynamic reconstruction of total or near total lip defects. Results of our series of four patients have been reviewed. Results The radial forearm flap – innervated pronator quadratus flap has been used in four patients thus far for lip reconstruction. This flap, in our limited series has shown excellent results in achieving oral competence, good motor function and acceptable cosmetic appearance. Conclusion The composite radial forearm–pronator quadratus flap is a promising new lip reconstruction technique that has potential to provide a higher level of oral competence, sphincteric function and symmetrical lip movement, than current microsurgical options in dynamic lip reconstruction. This method warrants further investigation in plastic surgery literature.

Combined ALT, Estlander, and Upper Lip Flap for Defects Involving the Oral Commissure

“…Although local flaps can provide up to 80% functional muscle and soft tissue coverage of lip defects, 4 a free or pedicled flap may perform better to avoid lip deformity. Nowadays, the forearm free flap is considered gold standard in reconstruction of large lip defects.…”

“…Nowadays, the forearm free flap is considered gold standard in reconstruction of large lip defects. 4 However, when malignant tumors that originate in the oral cavity invade the lips and corner of the mouth, such as oral mucosal or inferior gingival carcinoma, reconstruction of both the oral cavity and lips is required. In these cases, the volume of the forearm flap may be insufficient, making the reconstruction more difficult.…”

Total lower lip reconstruction: a review of recent advances

“…Grinsell et al proposed combining the RFFF with an innervated pronator quadratus on the same vascular pedicle to create a more dynamic lip reconstruction [36]. In their modified technique, the cutaneous RFFF is elevated in standard fashion and the pronator quadratus muscle is elevated based on arterial branches from the radial artery.…”

Променевий Клапоть Передпліччя В Реконструктивній Хірургії Голови Та Шиї. Досвід Застосування Та Вибір Венозної Системи Тканинного Клаптя

“…Дотепер ПКП залишається методом вибору для пластичного заміщення багатьох дефектів голови та шиї у онкологічних хворих. Так, він може бути використаний при реконструкції органів та тканин ротової порожнини, ротоглотки, гортаноглотки та пластичного усунення окремих дефектів основи черепа і м'яких тканин голови та шиї [2][3][4][5][6][7][8]. Крім того, ПКП може бути виділений як кістково-шкірний клапоть для заміщення невеликих кісткових дефектів нижньої та верхньої щелеп [9].…”