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The Use of Radial Forearm Free Flap for Total Lower Lip Reconstruction:The Analysis of 10 Consequentive Cases and Quality of Life Evaluation

Cezary Szymczyk, Adam Maciejewski, Janusz Wierzgon, Lukasz Krakowczyk, Maciej Grajek, Piotr Jedrzejewski, Miroslaw Dobrut,Ryszard Szumniak, Rafal Ulczok and Stanislaw Poltorak

Background: Postresective defect of the total lip, especially when associated with soft tissues of lower face still remains a challenge for adequate reconstruction. Among many options microvascular free tissue transfer is the latest major advance and the main contributing factor in the quality of life improvement. The modern techniques are able to deliver well-vascularised tissues which allow to reconstruct even most complex and extended defects. The aim of lip restoration is to provide proper oral lining and external cheek skin and to reconstruct oral competence. There are several issues in lower lip reconstruction using microvascular tissues that must be considered, including defect's size, aesthetic units, support, recreation of the vermillion and defects of associated tissues. Among many certain donor sites the radial forearm free flap (RFFF) has become a golden standard for majority of patients with total lip postressective defects. Materials and Methods: The aim of this paper is to present the group of 10 consecutive patients with lower lip cancer, where RFFF was used for functional lower lip reconstruction, with analysis of life quality. In the material the patient characteristics is presented with the details of RFFF modifications according to the type of lip suspension. Based on own QOL questionnaire, the functional and aesthetic results were analysed. Results: The results suggest that the careful and detailed planning of the size, shape and type of lip suspension influence both functional and aesthetic results. Static lip suspension for defects limited to lower lip only is comparable to dynamic suspension in cases where the defect is complex and extended. Results of quality of life analysis may be a predictive factor influencing the choice of individual flap modification including the type of lip suspension Conclusions: Our experience with free radial forearm free flap for total lip reconstruction suggests that the careful and detailed planning of the size, shape and type of lip suspension influence both functional and aesthetic results.