Semin Plast Surg. 2010 May;24(2):212-8. doi: 10.1055/s-0030-1255338.
The lips are highly visible structures on the face, providing oral competence and expressing emotion. The reconstruction of large full-thickness defects of the lips is a formidable challenge for the plastic surgeon. The most challenging defect of the lower lip is full thickness, larger than two thirds. Such an extensive defect requires either staged reconstruction or a flap of distant tissue. We consider that the gracilis muscle, due to its anatomic and functional features, is the ideal flap for reconstruction of the lips. A functioning gracilis matches all the requisites and allows normal movements that are uniform to all of the lip. The new commissure is symmetric and moves simultaneously with the residual commissure due to innervation by the facial nerve. Our indications to use the functioning gracilis muscle flap in lip reconstruction are as follows: resection of the lower lip larger than one quarter of the lip length in a patient younger than 60 years; resection larger than one third of the lip in all patients. When performing a free gracilis flap for lip reconstruction, we consider that, if possible, a facial artery musculomucosal flap and sensitive neurotization should be included to restore sensation of the reconstructed lip.
嘴唇是面部高度可见的结构，提供口腔功能并表达情感。嘴唇的大面积全层缺损的重建对整形外科医生来说是一个巨大的挑战。下唇最具挑战性的缺损是全层的，大于三分之二。如此广泛的缺损需要分期重建或使用远处组织的皮瓣。我们认为，股薄肌由于其解剖和功能特点，是重建嘴唇的理想皮瓣。具有功能的股薄肌符合所有要求，并允许与剩余的口角同时进行正常运动，因为它是由面神经支配的。我们使用功能性股薄肌瓣进行唇重建的指征如下：60 岁以下患者下唇切除大于唇长的四分之一；所有患者唇切除大于三分之一。当进行游离股薄肌皮瓣用于唇重建时，如果可能，我们认为应该包括面动脉肌黏膜瓣和感觉神经化，以恢复重建唇的感觉。
