Dermal Sling As an Alternative to Palmaris Longus Tendon Suspension in Radial Forearm Flap Lower Lip Reconstruction: A Case Report Publisher

Summary: Can a dermal sling replace the palmaris longus tendon in lower lip reconstruction? Research suggests it can provide stable support and preserve oral function without added risks. #PlasticSurgery #OralReconstruction

Garajei A ; Modarresi Z S ; Arab Kheradmand A ; Nazarpour Yousefdeh A ; Bakhtiari Z
Source: JPRAS Open Published:2026

Abstract

Background: Lower lip reconstruction with the radial forearm free flap (RFFF) requires reliable static suspension to maintain oral competence. The palmaris longus tendon (PLT) is commonly used for this purpose, but its absence limits applicability. We describe a dermal sling harvested from the RFFF as an alternative suspension method. Case presentation After total lower lip resection for squamous cell carcinoma, reconstruction was performed using an RFFF. A full-thickness dermal strip was harvested from the proximal flap, deepithelialized, and used as a non-tunneled, onlay suspension sling anchored bilaterally to the orbicularis oris muscle. Results: At 2-year follow-up, stable lower lip support was achieved with preserved oral competence, intelligible speech, and adequate oral intake. No drooling, flap failure, or donor-site morbidity occurred. Conclusions: The dermal sling provides a simple and reproducible alternative to PLT-based suspension in RFFF lower lip reconstruction, avoiding additional donor-site morbidity while ensuring durable static support. © 2026 The Author(s). Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. This is an open access article under the CC BY-NC-ND license. http://creativecommons.org/licenses/by-nc-nd/4.0/