Complex Salvage Lower Lip Reconstruction Using Gracilis Free Flap.

Background: The gracilis muscle microneurovascular free tissue transfer is a workhorse in dynamic facial reanimation. For patients with prior free flap reconstruction for large lower lip defects and in cases where local or regional tissue flap is inadequate for reconstruction, the gracilis free flap should be considered as a standard reconstructive option. Objectives: To define salvage lip reconstruction with gracilis muscle free flap. Methods: We performed chart review of four patients with history of total lower lip defects with prior free flap reconstruction who underwent salvage lip reconstruction for persistent defects using the gracilis free flap. Results: Cases were performed in four patients (three males, ages 55-70) with previous free flap reconstruction of the lower face (initial defect etiologies included 3 cancer, 1 necrotizing fasciitis) with remaining lower lip defects. We highlight our surgical technique and provide illustration of both obturator to hypoglossal (end-to-side) and distal facial and/or masseter (end-to-end) nerve coaptation. Conclusions: The gracilis free flap is a reasonable option for salvage reconstruction with the ability to improve lower lip function and aesthetic in patients with complex defects of the lower lip while harboring minimal donor site morbidity.