Lower Lip and Chin Reconstruction with Functional Myocutaneous Gracilis Flap

Abstract

Lower lip is an important anatomical unit in daily life activities, and its proper functional and aesthetic reconstruction is crucial. In the literature, both locoregional and microsurgical flaps have been described in lower lip reconstruction. Few authors have reported lower lip reconstruction with gracilis free flap. We describe a case of wide lower lip and chin avulsion caused by human bite reconstructed with an innervated gracilis free flap raised with its overlying skin paddle. The gracilis flap was harvested with a skin paddle of 7 × 5 cm, and vascular and nervous anastomoses were performed. At 9-month follow-up, an electromyography showed high muscle activities observed in the central part of the flap, and the patient achieved good oral functions reported with daily life activities. Raising the flap with the overlying skin paddle allowed us to avoid morbidity in other donor sites, avoid scar retraction of the skin graft on the gracilis that could limit its movement, and plan aesthetical refinements such as hair transplantation or tattoo of the beard on the skin.

Free Flap Reconstruction of the Lower Lip: A Systematic Review and Meta-Analysis

“…Thirteen articles 10 11 12 24 63 64 65 66 67 68 69 70 71 described 42 patients reconstructed with muscular free flaps to repair lower lip defects. The gracilis was the most used muscular free flap and was innervated in all cases ( n = 20, 8 articles).…”

Extended and unusual indications in jaw reconstruction with the fibula flap: An overview based on our 30-year experience

“…To overcome these limitations, in our hospital the surgical team include a senior consultant, a surgeon without great experience and a resident. Surgeries are performed with traditional techniques [ [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] ] and innovative methods [ [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] ] according to characteristics of the patient. An accurate selection of the case [ 54 ] is the key for successful application of new methods in terms of cost-effectiveness.…”

Upper limb traumatic injuries: A concise overview of reconstructive options

“…Of note, the surgical background can significantly interfere with the surgeon's choices in traumatic emergencies as well as in elective procedures both in hand and plastic surgery [ 37 ]. Different surgical aspects have to be taken into considerations when facing with the patient: detailed knowledge of the topic and all surgical solutions [ 38 ]; technical possibilities according to hospital class (hub or spoke center) and epidemiologic challenges such as emerging COVID-19 pandemic [ [39] , [40] , [41] , [42] ]; required instruments to perform microsurgery [ [43] , [44] , [45] , [46] , [47] ]; use of new technologies, innovative surgical methods and unconventional devices [ [48] , [49] , [50] , [51] , [52] ]; possibility to refer to skilled consultants; possibility to work in multi-equip with different specialists [ [53] , [54] , [55] , [56] , [57] , [58] ]; selection of high-risk surgical wound complications patients throughout available scores [ 59 , 60 ]; the help of skilled health professionals able to early detect possible complications and promptly start proper care and close follow-up [ 61 , 62 ]. …”