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

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.