In addition to a satisfactory esthetic appearance, oral competence is the ultimate goal in any lip reconstruction. It can be attained easily following repair of small lip defects. However, it seems elusive in most cases of reconstruction of large defects. Moderate defects of either the lower or upper lips can be repaired with local flaps resulting in adequate form and function. Large defects with total loss of the lower lip, however, are better reconstructed with distant composite flaps because locally available tissues in the cheeks and upper lip may be insufficient. Several authors1- 3 have described reconstruction of the lower lip with the composite radial forearm palmaris longus free flap using the tendon as a static sling. However, the vascularized palmaris longus tendon can be designed as well to create a new modiolus that could be suspended to the masseter muscle, achieving in a single operation simultaneously with soft tissue replacement a dynamic reconstruction with enhanced competence during mastication.
Atiyeh BA, Hashim HA, Hamdan AM, Kayle DI, Musharafieh RS. Lower Reconstruction and Restoration of Oral Competence With Dynamic Palmaris Longus Vascularized Sling. Arch Otolaryngol Head Neck Surg. 1998;124(12):1390-1392. doi:10.1001/archotol.124.12.1388