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Lower lip is an important anatomical unit in daily life activities, and its proper functional and aesthetic reconstruction is crucial. In the literature, both locoregional and microsurgical flaps have been described in lower lip reconstruction. Few authors have reported lower lip reconstruction with gracilis free flap. We describe a case of wide lower lip and chin avulsion caused by human bite reconstructed with an innervated gracilis free flap raised with its overlying skin paddle. The gracilis flap was harvested with a skin paddle of 7 × 5 cm, and vascular and nervous anastomoses were performed. At 9-month follow-up, an electromyography showed high muscle activities observed in the central part of the flap, and the patient achieved good oral functions reported with daily life activities. Raising the flap with the overlying skin paddle allowed us to avoid morbidity in other donor sites, avoid scar retraction of the skin graft on the gracilis that could limit its movement, and plan aesthetical refinements such as hair transplantation or tattoo of the beard on the skin.

Different locoregional and free flaps were described for oral soft tissues reconstruction after oncological resections; however, free flaps remain the first choice. Among free flaps, the radial forearm flap (RFF) and the anterolateral thigh perforator flap (ALT) are preferred the most. The lack of standardization of the flap choice leaves the selection to the surgeon's experience. The purpose of our observational study is to provide an algorithm to support the flap choice for the reconstruction of oral soft tissues. Sixty patients with squamous cell carcinoma of oral soft tissues were enrolled in our study. All the patients underwent preoperative magnetic resonance imaging (MRI) to measure the three-dimensional size of the tumor. During the follow-up, the patients were evaluated by using the University of Washington-Quality of Life Questionnaire. The questionnaire score was better for small tumors and worse for large tumors in both functional and relational fields. We observed that most of the overlapping results were obtained for small defects and the choice of RFF, as well as for large defects and the use of ALT. We observed that in the preoperative time, it is possible to select which flap between radial forearm and ALT is more appropriate for oral soft tissues defects reconstruction, according to the size of the tumor evaluated by MRI. We propose a decisional algorithm that suggests the type of flap to use between ALT and RFF.

Summary:. The use of a double-powered free muscle transfer for facial reanimation has been reported by several authors with different types of nerve coaptation. A new nerve coaptation strategy is presented herein. We performed a 1-stage double-powered free gracilis muscle flap transfer in a patient with long-standing facial paralysis by splitting the obturator nerve and anastomosing the 2 free ends to the contralateral facial nerve (through a sural graft) and to the masseteric nerve. Voluntary movement of the transferred muscle with teeth clenching was observed at 6 months after the operation and a symmetric smile with bilateral elevation of the mouth angle at 10 months. Our limited experience suggests that in case of a large cross-section of the obturator nerve, the latter can be split and sutured to the ipsilateral masseteric nerve and to the contralateral facial nerve with a sural graft by double end-to-end anastomosis.

No espaço urbano existem espaços destinados às edificações, à circulação de pessoas e às áreas livres (parques, jardins e quintais). Os dois últimos apresentam potencial capacidade para o desenvolvimento de espécies arbóreas e arbustivas, com benefícios para a melhoria da qualidade de vida no ambiente urbano, tão dotado de estresse do dia-a-dia. O presente trabalho objetivou realizar um levantamento da biodiversidade da arborização urbana de Guaxupé, sul de Minas Gerais. Foram identificadas e classificadas espécies arbóreas e arbustivas nas calçadas, rotatórias, avenidas (canteiro central), praças e jardins públicos. Verificou-se a ocorrência de 60 famílias, 158 gêneros e 227 espécies divididas conforme o hábito de crescimento em: 158 arbóreas, 41 arbustivas, 12 coníferas e 16 palmeiras, além de 3 que não foram identificadas. Quanto à origem, 55,05% dos indivíduos analisados são de espécies exóticas enquanto que 44,95% são de árvores nativas brasileiras. Conclui-se que a biodiversidade de Guaxupé é bastante rica, quando comparada a outras cidades , mas a arborização da cidade, aparentemente, não foi objeto de planejamento (salvo raras exceções em determinadas vias públicas), devendo o poder público adotar medidas como incentivo ao plantio de espécies nativas e estimular programas de educação ambiental, visando aproveitar o potencial de biodiversidade florística da cidade.