Author(s)
Nicole Craker, MD, MPH
Amit Patel, MD
Alexandra Kejner, MD
Affiliation(s)
University of Kentucky
Abstract:
Summary: This presentation describes the use of a hair-bearing bipedicled temporoparietal fascial flap for reconstruction of the lower lip. The presentation includes a discussion of relevant anatomy, surgical technique, pre-operative and post-operative images.Core: Medical Knowledge, Patient CareLevel V - Expert Opinion, case report or clinical exampleLearning Objectives: The hair-bearing bipedicled temporoparietal fascial flap is a reconstructive option for the lower lip and may be used to restore oral competence This flap is particularly useful in a patient with poor candidacy for free tissue transfer or local advancement flapsStudy: We report a case in which a hair-bearing bipedicled temporparietal fascial flap was successfully utilized for lower lip reconstruction and restoration of oral competence. Our patient had previously undergone composite resection of the entire lower lip, vestibule, floor of mouth, and mandible with free fibular flap reconstruction. After completing radiation therapy, he developed contracture of his free tissue transfer and ultimately oral incompetence. He wished to proceed with further reconstructive options to improve competence and to allow for dental rehabilitation. Given his previous neck dissection and the effects of radiation to local tissues, he was deemed a poor candidate for further free tissue transfer or local advancement flaps.Design: Case ReportMethod: A hair-bearing bipedicled temporoparietal fascial flap was elevated and inset into the soft tissue defect of the lower lip. A two-stage reconstruction was undertaken with division of the pedicle at the second stage.Results: Satisfactory reconstruction was achieved with both cosmetic improvement and restoration of oral competence. Minimal donor site scarring was encountered. The patient expressed satisfaction with his results.Conclusion: A hair-bearing bipedicled temporoparietal fascial flap is a viable option for reconstruction of the lower lip. This can be considered in patients that are unable or unwilling to proceed with free tissue transfer or local advancement flaps. The local nature of this flap provides excellent color match for facial reconstruction. Donor site morbidity is low and can be reconstructed with either skin grafts or skin substitute.