Forearm tendinocutaneous flap reconstruction in a patient with carcinoma of the mandibular gingiva extending deeply to the lower lip

Abstract

We experienced a case of carcinoma of the mandibular gingiva that extended deeply to the lower lip. Tumor excision while preserving the vermilion followed by forearm tendinocutaneous flap reconstruction was performed, which maintained good function and esthetics. The patient was an 84-year-old woman. The tumor was observed in the right mandibular gingiva （34mm×22mm） extending to the lower lip. A biopsy revealed a pathological diagnosis of squamous cell carcinoma. Resection was performed by bilateral neck dissection, with full-thickness resection of the lower lip while preserving the vermilion and marginal resection of the mandible. Defects in the oral cavity and lower lip were reconstructed by the forearm tendinocutaneous flap, and bridge tendon grafting was performed with the palmaris longus tendon for the resected orbicularis oris. The folded part of the forearm flap was de-epithelialized and sutured to the preserved vermilion. After the surgery, there was no insufficiency of the reconstructed lip, and the esthetic outcome was good. This method can maintain the sensation and muscle action of the lips by preserving the vermilion and should be considered in oral cancers extending to the lower lip if it is possible to preserve the vermilion.