Combined Karapandzic and radial forearm free flap with dual palmaris longus tendons for complex lip reconstruction

Abstract Background Near-total lip defects present a unique challenge preserving both oral competence and aesthetics. While lip reconstruction is commonly accomplished with local flaps to preserve function, in large defects, this technique alone can result in microstomia, speech inarticulation, and facial distortion. Free tissue transfer has become an attractive alternative, yet this approach presents its own set of functional challenges. Methods and Results For complex lip defects, the goal of reconstruction is preserving function and cosmetic appearance while avoiding debilitating microstomia. In this pictorial essay, we describe the anatomy, harvest, inset, and reconstructive approaches for using a combined Karapandzic and radial forearm free flap with dual palmaris longus tendons as an effective option for lip reconstruction in large ablative defects involving the oral commissure. Conclusion This novel technique uses local, regional, and free tissue to provide an excellent functional and cosmetic reconstructive option for this and similar large lip defects.