Transverse fascial suspension with muscle bow traction: advantages for full-thickness lip reconstruction involving the oral commissure using free flap

Large full-thickness oral defects involving the oral commissure continue to be a challenge for reconstructive surgeons. Although local flaps are the best option for full-thickness lip reconstruction, they are unavailable for large defects. In particular, recent advances in microsurgery have extended the available surgical options using free flaps, but for full-thickness large oral defects involving the oral commissure, it is still difficult to obtain good function and competence. The major disadvantages are the drooping and loosening of the reconstructed lip and the difficulty in restoring a natural oral commissure. We present two cases of lip reconstruction for full-thickness large defects involving the oral commissure in which free flaps with the muscle bow traction method were used to overcome these problems. In case 1, the lip was reconstructed with a free radial forearm-palmaris longus tendon composite flap. The tendon was sutured onto the orbicularis oris stumps. In case 2, the lip was reconstructed with a free anterolateral thigh flap including the fascia lata. A fascial strip in the flap was sutured to the residual orbicularis muscles. In each case, additional nonvascularised fascia lata was harvested and suspended the reconstructed lip in transverse direction as a muscle bow traction method. Both patients achieved good oral competence without medial deviation of the oral commissure and were able to resume a regular diet without drooping and loosening of the reconstructed lip. For large full-thickness oral defects involving the oral commissure, transverse fascial suspension with muscle bow traction is useful for functional and cosmetic reconstruction.