Functional reconstruction of the upper and lower lips and commissure with a forearm flap combined with a free gracilis muscle transfer.

After resection of an arterio-venous malformation of the upper and lower lips and commissure we performed reconstruction with a forearm flap combined with a free gracilis muscle transfer. First the motor nerve of the gracilis muscle was anastomsed to a buccal nerve branch in the cheek. In a second operation, the red lip was reconstructed with an oral mucosal graft, and the upper lip skin was reconstructed with a local flap. The patient obtained good oral sphincter function for eating, speaking and air inflation.