Traumatic loss of total lower lip and chin: The anterolateral thigh flap provides an optimal solution

Background: Young female presented 15 days after traumatic avulsion of total lower lip and chin. Considering the functional and aesthetic needs of the lower lip and chin, it is indeed challenging for the reconstructive surgeon to provide aesthetically appealing lower facial subunit with maintenance of good oral seal and competence. The authors present this case of total lower lip and chin loss reconstructed as a single aesthetic unit with free anterolateral thigh flap followed by secondarily defining the aesthetic subunits into lower lip and chin by selective liposuction. Method: Free anterolateral thigh flap was harvested. The fascia lata, harvested separately, was divided to form slings over which distal part of the flap, designated to form the lower lip, was hung over and inset into the remnant gingivolabial sulcus mucosa. This folded distal part of the flap formed the lining and cover of the lower lip. Result: After resurfacing with free ALT flap, she was able to attain lip seal and resume oral feeds within 3-4 days. She presented six weeks after the first surgery with severely reduced mouth opening. This was due to excessively tight perioral slings. Slings were released and flap was selectively debulked using liposuction so as to define the lower lip and chin subunits. Conclusion: Free anterolateral thigh flap is an extremely versatile option in the armamentarium of free flaps available. Primary thinning and good colour match along with negligible donor site morbidity makes it meritorious over the radial forearm flap. Keywords: Fascia lata sling, Selective debulking, Aesthetic subunit, Total lower lip and chin reconstructio