Outcomes following vy advancement flap reconstruction of. These flaps of skin are added to the injured lip to restore it. Various plans of lip reconstruction with switched flaps the patient was returned to the operating room where the flaps were separated and wider excision was obtained from the lower lip. Reconstruction of the lower lip is the most important, 4, 5, 6 because oral competence depends greatly on a functional lower lip having good muscular function and an adequate height and sensation. Defect of 30% of the upper or lower lip can be closeddefect of 30% of the upper or lower lip can be closed primarily great elasticity of. Functional lower lip reconstruction with the partial. Lower lip reconstruction is ideally achieved with innervated flaps that supply mucosa, functional muscle, and skin. Case reports case 1 a 61yearold caucasian male presented with a lesion involving his lower lip and chin fig.
The reconstruction of large fullthickness defects of the lips is a formidable challenge for the plastic surgeon. General considerationsgeneral considerations for upper lip reconstruction, lower lip can be used, butfor upper lip reconstruction, lower lip can be used, but vice versa is avoided. We present a case of lip reconstruction following a total resection of the upper lip. Squamous cell carcinoma accounts for 95% of lip malignancies with 90% of cases affecting the lower. Yamauchi m, yotsuyanagi t, yokoi k, urushidate s, yamashita k, higuma y.
There were concomitant chin and mandible defects in three and four patients. The advantage of the technique is that restoration of the orbicularis. Free flap reconstruction is often required for largescale defects with associated loss of mucosa, cheek, nasal, and chin skin that exceed the availability of local soft tissue. The split orbicularis myomucosal flap for lower lip reconstruction. Reconstruction of medial lower lip defects after tumour. Patients underwent assessments at 2, 4, 6, 12, and 18 months postoperatively. One half to two thirds of lower lip defects larger than one half of the lip cannot be closed primarily without undue wound tension. Functional lower lip reconstruction with a forearm flap combined with a free gracilis muscle transfer.
The increasing success rate of free flaps along with their reconstructive advantages have got them into regular practice options in maxillofacial reconstruction. This section will discuss different aspects of free flap reconstruction. Reconstruction of total lower lip and chin defects using. Empowered static and partial dynamic reconstruction. The lip cancer is removed in a rectangular fashion with appropriate free margins. This pdf is available for free download from a site hosted by medknow publications. Individual patient factors, such as previous operations, underlying comorbidities, compliance, and mechanisms for the wound defect, may affect choices of reconstruction. The muscles must be carefully repaired to avoid numbness in the lip. Functional and cosmetic considerations must be included in any lip or chin reconstruction.
This type of reconstruction is primarily used for large skin and soft tissue defects typically involving greater than 80% of the lip. Ninkovic m, spanio di spilimbergo s, kim evans kf, ninkovic m. If there is a deep wound or hole in the lip, mucosa, or mucus membranes can also be used to fill in the area. Squamous cell carcinoma accounts for 95% of lip malignancies with 90% of cases affecting the lower lip. A more complicated reconstruction method involves transplantation of the soft tissue from another part of the body with the accompanying blood vessels to reconstruct and build a new lower lip, also known as the free flap procedure or microvascular free tissue transfer. Reconstruction of lower lip defect is a challenge for oral and maxillofacial surgeons. Algorithms for reconstruction of the upper and lower lips are detailed. Original article fan flaps for cheiloplasty lower lip reconstruction.
Other causes include trauma, burns, infectious diseases, hemangiomas, and congenital clefts. Old age lower lip cancer defects reconstruction by abbe. The most challenging defect of the lower lip is full. Lip defects can be classified according to thickness of the defect ie, skin or mucosa only, fullthickness and overall size of the defect. The procedure used in this case was a combination of bilateral nasolabial flaps with a submental flap and buccal mucosal. Objective to characterize revision surgery following vy subcutaneous tissue pedicle advancement flap repair of large upper lip skin defects methods.
Strategies for closure involve borrowing tissue eitherfrom theopposite lip or from the cheek. Lip reconstruction after tumor ablation world journal of plastic. Furuta s, sakaguchi y, iwasawa m, kurita h, minemura t. Conclusion human bites are potentially dangerous for their propensity in causing infections at the site of bite injury as well as posing a potential risk. Total lower lip reconstruction with a sensate composite radial forearmpalmaris longus free flap and a tongue flap.
This is the first report of a simultaneous total upper and lower lip reconstruction. Reconstruction of the lower lip due to subtotal and total tissue defects was performed using latissimus dorsi free flap on twelve patients, between 20 and 2017. Basically it represents a skinmusclemucosal flap for lower lip reconstruction. This is more so when the resection is total and a complete lip has to be constructed. Margins were free and there were no lymphovascular emboli or perineural invasion. Jagadeesh abstract department of plastic surgery, medical college, calicut. Tissue borrowing from the op posing lip was first described by sabattini in 1838,7andis. The etiology was squamous cell carcinoma in six patients, malignant melanoma in one, firearm injury in three and microstomia in two. Lower lip reconstruction journal of plastic, reconstructive. The lips are considered the beginning of the oral cavity and are the most common site of oral cancer.
Reconstruction of massive lower lip defect with the composite radial forearmpalmaris longus free flap. The most challenging defects of the lower lip are full thickness and larger than two thirds of the lip. Eightmonth followup after radial forearm freeflap reconstruction of lower lip defect. A method for reconstruction of the lower lip following larger subtotal excision is described. Total lower lip reconstruction utilizing bilateral. Lower lip reconstruction using a functioning gracilis. Address correspondence and reprint requests to minoru miyake, dds, phd, department of oral and maxillofacial surgery, faculty of medicine, kagawa university, 17501 ikenobe, miki. We believe that surgeon should preserve a continuity of the free margin of upperlip if possible. Lip reconstruction may be required after trauma or surgical excision. The bilateral staircase technique of johanson et al. As a result of the relatively lower incidence of cancer, the. We report our experience with this form of reconstruction in 10. Reconstruction of the lip commissure with upper and lower.
The authors describe a new technique of onestage total lower lip reconstruction, with the ultimate goal being achievement of the delicate balance between adequate mouth opening and. Conclusion human bites are potentially dangerous for their propensity in causing infections at the site of bite injury as well as posing a potential risk for transmission of systemic diseases. The patients mandibular and intraoral mucosal defect was reconstructed with a free. Any reconstruction of the lips must include both functional and cosmetic considerations. Forearm soft tissue is an ideal site given its thinness and pliability. A medline search of scientific literature was conducted, with an emphasis on 1980 to the present. This can be due to paucity of available soft tissue, previous radiation therapy, or previous surgery fig.
Lower lip reconstruction using a functioning gracilis muscle free. Although associated complications are inevitable in a percentage of patients, it is good. Microvascular free flap is the main choice for lip cancer reconstruction recently but still have several morbidities presented, especially for elderly, like long surgical time and difficulty in denture fabrication. Reconstruction of the lips, oral commissure, and fullthickness cheek with a composite radial forearm palmaris longus free flap. Physical examination revealed a 3cm mass on the lower lip and an 8cm. The options range from direct closure of the defect, to local and free flaps. Onestage reconstruction of a large defect of the lower lip and oral commissure. Reconstruction of concomitant total loss of the upper and lower lips with a free vertical rectus abdominis flap. Flap was supported with fascia lata sling anchored to the.
The total lip defects resulted from tumor resection n6, trauma n3, and noma n1. Plastic surgery unit, the prince of wales hospital, randwick. Free tissue transfer is a critical tool for lip reconstruction. Lower lip reconstruction strategies patient had a lesion covering 90% of the lower lip that was reconstructed using the websterbernard technique and a tongue flap figure 7, table 1. Large lower lip defects karapandzic flap may be used in lesions up to 80% of lip, may cause microstomia bernardburows procedure provides new lip tissue, but sensation and competence problems can lead to drooling free flap may be. Reconstruction of extensive lower lip defects is difficult. Reconstruction for a large lower lip defect is surgically challenging, especially reconstruction with local flaps. It is a modification of the gillies fan flap 3, which is best indicated for the reconstruction of central defects. Here, we present a 52yearold male with a large t3 scc, which started years before this treatment and involved nearly all of his lower lip, oral commissure and upper lip. For the initial three days patient was allowed liquid diet only.
Freeflap reconstruction is often required for largescale defects with associated loss of mucosa, cheek, nasal, and chin skin that exceed the. Pdf salvage of free radial artery forearm flap following. Pdf reconstruction of massive lower lip defect with the. Lip reconstruction surgery in these cases typically uses skin grafts. One stage reconstruction of large lower lip carcinoma. The karapandzic technique was introduced in 1974 for lower lip reconstruction. Once the defect involves the whole lower lip and extends onto the chin it is necessary to consider distant flaps. Lower lip carcinoma reconstruction using abbe estlander flap. Reconstruction of the lower lip and chin with the composite radial forearmpalmaris longus free flap. The composite radial forearmpalmaris longus tendon free flap has been described by sakai et al, 3 as a new technique for reconstructing total lip and chin defects. Here, the authors report their use of this method for lip reconstruction in a 94yearold japanese female after the removal of a cancerous mass. Fusuma sliding flap for lip reconstruction of lower lip.
Aside from gracilis myomucosal flap descriptions 4, this method provides the only other option for competent and potentially dynamic lower lip reconstruction with maintainence of oral opening for cases involving total lower lip defects. Oncologic resection of cancer remains a major cause of large lip defects. Currently, the preferred reconstruction method for subtotal lower lip defects is a free flap orif this is not possiblelocal flaps. Total reconstruction of the upper lip using bilateral. Lower lip reconstruction using the karapandzic technique. Subtotal lip reconstruction using an innervated free gracilis muscle flap. During this period, one patient who underwent reconstruction with a myomucosal flap and. Pdf lip reconstruction poses a particular challenge to the plastic surgeon in. The scalp visor flap offers a simple but extremely versatile tool for use in midfacial reconstruction, especially in the male, providing neolip tissue, a moustache and a beard. Even small abnormalities can be apparent because of the prominent location on the face. Free flaps and grafts are the next choices for reconstruct ion of post tumor excision lip defects. The planning and choice of operative methods depended on the quality of the surrounding tissue and the patients age, sex, occupation, and general health. Our modified abbe flap can be applied for a various defects of the upper lip so far as the free margin of the vermilion can be preserved. The method is based on the principle introduced by stein and modified by estlander, abbe, kazanjian, and converse, and seems to be especially valid in cases of older patients with redundant upper lip tissue.
Dual free flap reconstructions can be employed to reconstruct these extensive intraoral and extraoral defects. These flaps should be capable of being used when vermilionectomy is necessary. Lip reconstruction plastic and reconstructive surgery. A a 21yearold man with a sclerosing basosquamous cancer of the left inner lower lip and chin. Our preferred method of commissuroplasty is included to address blunting of the oral commissure, a common sequelae following lateral lip reconstruction. Reconstruction e i iure i uer a er i uie ee uig ubea a aabia a.
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