# Complete loss of lower lip in a one-year-old treated with delayed free tissue transfer: a case report and comprehensive review of the literature

## TL;DR

A one-year-old child successfully underwent complex lip reconstruction after a severe injury, showing that advanced surgical techniques can restore function and appearance in young patients.

## Contribution

This case demonstrates the feasibility of free flap reconstruction in very young children for complete lower lip loss.

## Key findings

- Radial forearm free flap with tendon suspension successfully reconstructed a one-year-old's lower lip.
- Multidisciplinary care and individualized planning led to functional and aesthetic success in a pediatric patient.
- Postoperative complications were managed with revision surgery, achieving oral competence and reduced sialorrhea.

## Abstract

Pediatric lower lip reconstruction is rare and technically challenging due to small donor sites, ongoing facial growth, and functional demands, such as speech and oral competence. We present the case of a one-year-old male who sustained complete avulsion of the lower lip from a dog bite. Initial management included a Karapandzic advancement flap for coverage. Definitive reconstruction at 23 months involved a radial forearm free flap with palmaris longus tendon for static suspension, augmented by acellular dermal matrix. Postoperative dehiscence required revision vestibuloplasty with a split-thickness skin graft. The patient achieved adequate lip suspension, improved sialorrhea, and restoration of oral competence by the first postoperative visit. Free flap reconstruction of the lower lip in children under two is feasible and can yield functional and aesthetic outcomes when individualized planning and multidisciplinary care are employed.