Reconstruction of a subtotal upper lip defect with a facial artery musculomucosal flap, kite flap, and radial forearm free flap: a case report

Abstract

BackgroundFor reconstructive surgeons, massive midface defects, including large, full-thickness wounds on the upper lip, can be very challenging. Although there are many methods for reconstruction of upper lip defects, it is difficult to obtain satisfactory restoration of oral functions and good cosmetic results.Case presentationThis case report presents a man with massive midface defects, including upper lip, left nose, and cheek defects. Over the previous 2 years, the patient had three reconstructions with sequential free flaps for the resection of recurrent tumors, the first of which was in March of 2016; this resulted in the patient having massive midface defects, including an upper lip defect, a defect on the left side of the nose, and one on the left cheek. The defects were reconstructed using a radial forearm free flap (RFFF), a facial artery musculomucosal (FAMM) flap, and a kite flap. In June 2016, he underwent a second reconstruction, this time of the left nose defect, using a left anterolateral thigh (ALT) flap. In March of 2017, the patient underwent a third reconstruction with the use of a free ALT on the left intraoral cheek and the defects on the neck. All flaps survived. No complications were encountered postoperatively. The patient regained good oral sphincter function with no reports of drooling. Although the patient underwent three surgeries, the reconstruction results were acceptable.ConclusionsFor massive midface defects, including large, full-thickness wounds on the upper lip, the combination of a FAMM flap, kite flap, and RFFF promotes the reconstruction of the complex midface structure and improves the resulting functionality.

Facial Reconstruction Using Facial Artery Myomucosal Flap: A Comprehensive Review

“…Once the patient is selected and the FAMM flap is decided to be the best option for the case, preoperative preparation is important to optimize the results [ 19 , 40 ]. Preoperative preparation consists of the localization of the facial artery using Doppler ultrasound [ 22 , 41 , 42 ], and localizing the parotid duct (Stensen’s duct) [ 17 ].…”

Laser Resurfacing after Facial Free Flap Reconstruction

“…In such cases, surgical techniques such as local flap, skin graft or free flap can be used to cover the defect. [1][2][3][4] Also biologic dressing materials can be used to enhance the healing process of the defect without surgical coverage. Small defects can be dealt with local flap coverage or secondary intention healing, but defects of large size and depth usually require free tissue transfer such as skin graft or free flap coverage.…”