Gracilis free muscle transfer for morpho-functional reconstruction of the lower lip

Background. Large full-thickness defects of the lower lip need free tissue transfer. The free forearm flap is the more widespread technique for free flap lower lip reconstruction, but it results in a static lip. The authors describe a technique of morphodynamic sensate reconstruction of the lower lip with a free gracilis flap and a musculomucosal flap. Methods. Three patients underwent reconstruction with an innervated free muscular gracilis flap, an innervated musculomucosal flap for the vermillion (2 cases), and a full-thickness skin graft. Results. No significant complications were observed. Static function and vermillion sensitivity were immediately restored. The skin color match was excellent. After 9 months, contraction of the transferred muscle was evident. Conclusion. The lip is a dynamic unit. The innervated gracilis muscle seems ideal for lip reconstruction in that it correctly replaces all the lip layers and compensates for the lost function much better than a static technique