Abstract

Objective: To report the successful use of the Facial Artery Musculomucosal (FAMM) flap for the reconstruction of an extensive lower lip defect following resection of a squamous cell carcinoma (SCC). Background: SCC of the lower lip is a prevalent malignancy associated with significant tissue defects post-resection, necessitating effective reconstructive techniques to restore both function and aesthetics. The FAMM flap, introduced by Pribaz et al., offers a reliable method for addressing such defects due to its rich vascular supply and versatility. Case Presentation: A 31-year-old male with a history of tobacco use presented with a 3.2 cm ulcerative lesion on the lower lip. Diagnosis of moderately differentiated SCC was confirmed, and imaging showed no regional lymphadenopathy or distant metastasis. The patient underwent wide local excision, resulting in a substantial defect involving up to 75% of the lower lip with bilateral level I, II, III selective elective neck dissection. Surgical Technique: A FAMM flap was designed and harvested from the ipsilateral buccal mucosa, ensuring inclusion of the facial artery’s perforators to maximize vascularity. The flap was transposed to the lower lip defect with tunneling through buccal mucosa with meticulous alignment of the vermilion border and restoration of muscular continuity. The donor site was closed with kollagen sheet. Outcome: Postoperative recovery was uneventful, with the flap demonstrating excellent viability and integration. The patient achieved favorable functional and aesthetic outcomes, including restored oral competence and satisfactory cosmetic appearance. No disease recurrence and no trismus were noted at the six-month follow-up. Conclusion: The FAMM flap is an effective reconstructive option for extensive lower lip defects resulting from SCC resection. Its ability to provide well- vascularized, functional tissue with minimal donor site morbidity makes it a valuable technique in complex oral and perioral reconstructions.