Dermal sling as an alternative to palmaris longus tendon suspension in radial forearm flap lower lip reconstruction: A case report

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.