Summary
Background
Reconstruction of total full-thickness lower lip defects combined with extensive composite
mandibular defects particularly in the setting of close-range high-energy ballistic
injury presents a formidable challenge for the reconstructive plastic surgeon. While
the fibular flap has been widely accepted for its usefulness in the reconstruction
of composite mandibular defects, to date, there is no definitive widely established
method of total lower lip reconstruction. The article presents authors' approach using
innervated gracilis muscle flap for total lower lip reconstruction in the setting
of high-energy gunshot injuries to the face.
Methods
Three patients underwent composite mandibular defect reconstruction using fibular
osteocutaneous flap and functional lower lip reconstruction using innervated gracilis
muscle flap. Lip lining was reconstructed using the skin paddle of the fibular flap.
The external surface of the gracilis muscle was skin-grafted. Facial artery myomucosal
flap provided vermilion reconstruction in two patients.
Results
All fibular (n = 3) and gracilis flap transfers (n = 3) were viable. An electromyographic study at 1 year postoperatively demonstrated
successful re-innervation of the gracilis muscle. Starting at about 10 weeks postoperatively,
patients exhibited voluntary lip movements and oral competence. In addition, all patients
achieved near-normal speech, evidence of recovered protective sensitivity and satisfactory
appearance. The mean follow-up was 16.1 months.
Conclusions
Our preliminary report in three patients demonstrated that innervated gracilis muscle
transfer combined with fibular flap provides a successful reconstruction of extensive
composite mandibular and total lower lip defects resulting from gunshot injuries to
the face. Oral continence was achieved by combination of regained tonicity and voluntary
movement of the gracilis muscle following re-innervation and assistance of the cheek
muscles on the gracilis muscle. The described technique was reliable and the results
were promising.
Keywords
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Article info
Publication history
Published online: May 31, 2012
Accepted:
April 26,
2012
Received:
December 30,
2011
Footnotes
☆This article has been presented in ‘Innovations in Plastic and Reconstructive Surgery’ Cleveland Clinic, Ohio, 14–15 October, 2010 and in ‘3rd Congress of the Armenian Association of Plastic, Reconstructive and Aesthetic Surgery and the ISAPS Satellite Symposium’, Yerevan, Armenia, 28–30 June, 2011.
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
