Friday, October 31, 2008
14179

Simultaneous Reconstruction of Total Loss of Both Lips – A Rare Challenge, Converting Ghastly to Socially Acceptable Female – A Case Report

Surinder Makkar, MBBS, MS, MCh

Simultaneous reconstruction of total loss of both lips is a challenge for reconstructive surgeon and is reported rarely in literature. The case being presented is a 18 year female reporting to outpatient with a ghastly appearance, having total loss of both lips extending to both cheeks. At the age of 8years, she had accidental blast injury from jaggery (eatable prepared from sugarcane juice) mixed with explosives placed unattended to kill animals. She couldn’t seek treatment due poverty and lack of awareness. Reconstruction of both the lips was done with microsurgical transfer of double neurosensory fasciocutaneous radial artery forearm flap with vascularised palmaris longus in first stage and vermilion reconstruction of both the lips was done with single tongue flap in subsequent stages. We could achieve satisfactory reconstruction of lip and vermilion with regard to height, sensations, color match, competence for solids, no drooling of saliva at rest. Shortcomings of reconstruction were lack of complete competence for liquids mainly at angle of mouth, mild restriction of mouth opening and fish mouth like appearance. There was no significant donor site morbidity of both forearms and tongue in terms of function. So, simultaneous reconstruction of complete loss of both lips is feasible by double free radial artery forearm flap. Using two flaps adequate amount of tissue is available and there is freedom to place the tissue in different anatomical location. One tongue flap can be used for reconstruction of both lips and it gives good color to vermilion. Satisfactory competence for solids and no drooling at rest can be achieved with neurosensory flap and palmaris longus sling used as static method of reconstruction.