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 cm². 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%. Ail 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.