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

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