Sensory Recovery with Innervated and Noninnervated Flaps after Total Lower Lip Reconstruction: A Comparative Study

This study compares sensory recovery after total lower lip reconstruction in a wide variety of flaps including bilateral depressor anguli oris flap, submental island flap, bilateral fan flaps, radial forearm flap, and pectoralis major myocutaneous flaps in a large number of patients. Spontaneous return of flap sensation was documented by clinical testing in the majority (3%) of patients who underwent total lower lip reconstruction. Sensory recovery occurred more often in patients with fasciocutaneous free flaps than in those with musculocutaneous flaps. Flap sensation to touch, two-point discrimination, and temperature perception was correlated with age, smoking, and radiation treated patients. We conclude that reasonable sensory recovery may be expected in noninnervated flaps, provided that the major regional sensorial nerve has not been sacrificed, and also provided that the patients age is relatively young and that enough surface contact area of the recipient bed is present without marked scarring. This trial was regestered with Chinese Clinical Trial Registry (Chi CTR) with ChiCTR-ONC-13003656. 1. Introduction The reconstruction of an extensive lower defect is a difficult surgical challenge since both aesthetics and function of the lower third of the face have to be restored. The lip is a complex anatomical structure which includes a muscular layer which is a part of the oral sphincter, lying between a muscular layer and the overlying skin. In order to restore the three layers, several reconstructive procedures have been described, including local flaps from the cheeks, pedicled flaps from the chin, expanded cervical or jugal flaps, and finally fasciocutaneous free flap transfers [1–4]. Nevertheless, none of them provide an ideal solution regarding the appearance and function. In this study we present 125 innervated and noninnervated flaps performed in bothclinics in 65 patients with stage 3 and further squamous cell carcinoma of the total lower lip. To date, 80 patients have been followed-up for a minimum of 1 year after the tumor resection and reconstruction with bilateral fan flaps, Karapandzic flaps, Nakajima flaps, Fujimori gate flaps, submental island flaps, bilateral depressor anguli oris myocutaneous flaps, pectoralis major myocutaneous flaps, and noninnervated radial forearm flaps was performed. The comparative clinical recovery of sensation in these flaps and its relationship to articulation and perioral continence form the basis for this report. 2. Materials and Methods From January 1, 1999, to August 2010, 80 patients, ranging in age