CLINICAL ARTICLE Reconstruction of lower lip defects with free super-thin anterolateral thigh flap Zulfukar Ulas Bali MD 1 | Burak Ozkan MD, FEBOPRAS 2 | Aziz Parspancı MD 1 | Yavuz Kececi MD 1 | Levent Yoleri MD 1 1 Celal Bayar University Department of Plastic, Reconstructive and Aesthetic Surgery, Manisa, Turkey 2 Baskent University Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara, Turkey Correspondence Zulfukar Ulas Bali, MD, Celal Bayar University Department of Plastic, Reconstructive and Aesthetic Surgery, Manisa, Turkey. Email: zulasbali@gmail.com Abstract Background: Lower lip is a vital organ with important functions as well as aesthetic importance. It is critical to provide an aesthetically appealing lower facial subunit with maintenance of understandable speech and oral competence. Achieving these targets is very difficult especially in total lower lip defects. This report presents a technique using super-thin anterolateral thigh (ALT) flaps with fascia graft for reconstruction of large, complex oral sphincter defects. Patients and methods: Six patients with squamous cell carcinoma (SCC) and one patient with a gunshot injury were presented in this report. All of them had full- thickness defects including skin, orbicularis muscle and oral mucosa. The mean age was 58 (range, 32–85) years. Defects of the lower lip were reconstructed with a super-thin ALT flap. Super-thin flaps were obtained by planning as close to the knee as possible and elevating at the level of superficial fascia. The fascia graft was used for achieving lip suspension. Results: Overall flap survival was 100%. The flap size ranged from 8 × 6 cm to 14 × 10 cm. The follow-up periods ranged from 6 to 14 months. All the patients achieved acceptable oral competence, both in the resting condition and during speak- ing and eating, except for one patient who had a drooping lower lip developed in the post-operative 3rd month and underwent a secondary tightening procedure. Another patient needed liposuction due to bulky appearance. Conclusion: Super-thin ALT flaps seem to be a useful option for functional and aes- thetic reconstruction of extensive lip defects. 1 | INTRODUCTION Lower lip defects lead to functional losses such as speech, nutrition, and aesthetic impairment. Although there many techniques have been described for both functional and aesthetic reconstruction of lower lip, there is no ideal technique for aesthetic reconstruction of this ana- tomical region due to its unique structure. The first choice among the tissues to be used in lower lip reconstruction are the healthy parts of the lower lip. When the healthy parts are insufficient or impossible to use, the upper lip can be used instead (Chen et al., 2020). In larger defects, reconstruction techniques using tissues around the lips have been described, such as cheek advancement flaps (Webster et al., 1960), Karapandzic flap (Karapandzic, 1974), nasolabial flaps (Fujimori, 1980; Nakajima et al., 1984), and their combinations (Uglesic et al., 2019). Free tissue transplantation is generally required for the defects involving more than 80% of the lip. Various free fasci- ocutaneous flaps such as radial forearm flap (Carroll et al., 2000), anterolateral thigh flap (Yu, 2004); muscle flaps such as gracilis (Coskunfirat et al., 2017) and latissimus dorsi (Ueda et al., 2009) were described in the literature for this type of defects. The anterolateral thigh (ALT) flap is considered as a workhorse flap for soft tissue reconstruction with advantages including availability of a Received: 9 May 2020 Revised: 30 July 2020 Accepted: 23 October 2020 DOI: 10.1002/micr.30681 Microsurgery. 2020;1–7. wileyonlinelibrary.com/journal/micr © 2020 Wiley Periodicals LLC 1