Functional reconstruction of complex lip and cheek defect with free composite anterolateral thigh flap and vascularized fascia

BACKGROUND: Extensive composite defects involving the lip and cheek present difficult reconstructive challenges. This study presents a technique using anterolateral thigh (ALT) flaps with vascularized fascia for large complex oral sphincter defect reconstruction. METHODS: Fifteen patients who had undergone oral cancer ablation were enrolled in the study. The average area of intraoral lining and cheek-lip skin defects was 96.9 cm(2). Upper-lip defects ranged 0% to 60%, and lower-lip defects ranged 20% to 80%. Skin and intraoral lining defects were replaced by an ALT fasciacutaneous flap. The vascularized fascia of the flap was used to provide lip suspension. RESULTS: Flap survival was 100%. All but 1 patient had good static suspension. Nine patients had adequate oral competence without drooling, but 6 had occasional oral incontinence. All patients achieved an acceptable appearance. CONCLUSIONS: For extensive cheek-lip composite defects, ALT flap together with vascularized fascia has proven to be a useful option for functional reconstruction.