Reconstruction after resection of large tumors of the lower lip requires the use of free flaps in order to restore the shape and the function of the lip, with the free radial forearm flap being the most popular. In this study we describe our experience in using the dorsalis pedis free flap as a salvage option in reconstruction of total lower lip defect in a patient with an extended lower lip carcinoma after failure of the radial forearm free flap, that was initially used. The flap was integrated excellently and on the followup the patient was free of disease and fully satisfied with the aesthetic and functional result. 1. Introduction Treatment of choice for lower lip cancer is wide full thickness excision and reconstruction of the remaining defect. Extended lower lip defects resulting after excision of large tumours (involving >2/3 of the lip) represent a very difficult reconstructive problem and include the use of locoregional flaps or free flaps. The aim of reconstruction is closure of the defect and restoration of lip function. Regional flaps like bilateral advancement flaps, Karapandzic flap, and Gilles fan flap are not effective because they result in microstomia and create extended facial scarring and dysmorphia [1–3]. Total lower lip excision defects can only be satisfactorily closed with the use of composite free flaps [4–9]. The ideal free flap should be thin and pliable in order to be shaped to reconstruct the lower lip and provide sensitivity and support in order to avoid drooling. The free flap that gathers all these properties is the free radial forearm flap, and thus it is the most commonly used free flap in the case of reconstruction of the lower lip. Flap necrosis is an unfortunate event that has to be confronted with the use of another flap. The substitute flap can be the dorsalis pedis free flap, since it resembles in its characteristics the radial forearm flap. We present our experience with the use of the dorsalis pedis flap as an alternative composite fasciocutaneous tendon flap in total lower lip reconstruction. 2. Materials and Methods We present the case of a 65-year-old male patient with extended lower lip cancer involving more than 2/3 of the lower lip (Figure 1). Biopsy showed a high grade squamous cell carcinoma and CT scan of the neck revealed no lymph node metastases. The patient underwent total lower lip excision and bilateral supraomohyoid selective neck dissection (Figure 2). A composite radial forearm-palmaris longus free flap was harvested from the right arm according to the size of the oral mucosa and external face
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