Functional lower lip reconstruction with the modified Bernard-Webster flap

Functional and esthetic reconstruction of composite lower lip defects with a motor-innervated chimeric facial artery buccinator myomucosal-submental island flap

OBJECTIVE

This study aimed to assess the functional and esthetic outcomes of a chimeric innervated buccinator myomucosal-submental island flap (BMM-SIF) for large composite lower lip reconstruction.

METHODS

This retrospective study included five patients who underwent lower lip tumor resection and BMM-SIF reconstruction at the Hospital of Stomatology, Sun Yat-sen University, between August 2021 and February 2023. Lip function was evaluated using water leakage, cheek puffing tests, and superficial electromyography. Lip appearance was observed using photographs and evaluated through subjective interviews. Donor-site conditions, including facial symmetry and mouth opening, were monitored.

RESULTS

All the BMM-SIFs survived. Drooling was the main complication observed shortly after surgery. The water leakage test showed complete oral competence for liquid holding in the 7th month; however, moderate air leakage was present in two patients. Electromyography revealed myoelectric signals from the innervated buccinator at the recipient site. Facial expression and food intake were typically managed. The shape and projection of the vermilion were harmonious and satisfactory for each patient. Neither microstomia nor mouth opening limitation was observed, with an average inter-incisor distance of 37.25±4.4 mm.

CONCLUSION

Chimeric motor-innervated BMM-SIF effectively reconstructed large full-thickness lower-lip defects with satisfactory functional and esthetic outcomes.

Lip Reconstruction by Double Layer and Double Flap New Combination Technique: A Case Series

In the past, lip reconstruction after ablative surgery has been performed by primary closure and more recently by free flap transfer technique. Cheek’s skin flap has been used to reconstruct the lower lip cutaneous portion. This study presents a reconstructive method for the vermillion and the lip’s cutaneous portion using the Goldstein–Robotti techniques (for the vermillion) and the buccinator flap to reconstruct the cutaneous lip portion and the perioral muscles. This procedure allows a complete reconstruction with a double layer technique for defects of more than one-third of both lips, together or alone, including modiolus, showing satisfactory functionality and aesthetics. The procedure was carried out by splitting the buccinator muscle and elongating the upper and lower buccinator bundles, together or alone. Soft tissue blunt dissection prevented most facial nerves and vessels injuries, ensuring blood supply and an amount of lip sensitivity. Even in the case of facial vessel ligatures after neck dissection, the technique was possible basing the flap pedicle on the internal maxillary artery branches (buccinator) and contralateral facial vessels (orbicularis). We present a case series of six reconstructions of various defects of the upper and lower lips, including the commissure after ablative surgery for squamous cell carcinoma and polymorphous adenocarcinoma. The results showed satisfactory functional and aesthetic outcomes, with similar tissue texture, static and dynamic symmetry achieved for all the patients.

The Use of Vastus Lateralis Muscle Flap for Functional Lip Reconstruction

BACKGROUND

Total or near-total lip defects poses a serious challenge to a reconstructive surgeon with static procedures not providing desired functional and aesthetic outcomes. The dynamic lip reconstructive methods using functional muscles have become a current issue in recent years showing admirable results. This study present 3 cases of successful total and near-total lip reconstruction are presented using vastus lateralis muscle.

METHODS

This is a retrospective analysis of a consecutive series of 3 patients (2 men and 1 woman) aged 44 to 56 years (mean) who had resection of extensive squamous cell carcinoma 2 had both upper and lower lip involved and 1 had lower lip involvement only. After resection patients had near total full thickness lower lip defect and 40% upper lip defect. The innervated vastus lateralis muscle free flap was transferred to the lip and end-to-end vascular anastomosis on the facial artery and end-to-side to internal jaguar vein was performed. The marginal mandibular branch of the facial nerve was used for nerve coaptation. The inner and outer surfaces of the flaps were grafted with a thick-split-thickness skin graft. Drooling rating scale and patient and observer scar assessment scale as well as electromyography were performed to evaluate oral competency and aesthetic outcome.

RESULTS

All patients underwent single stage near-total lower lip and 2 had part of upper lip reconstruction successfully and survived the surgical operation. One patient lost the skin graft and was managed consecutively and muscle granulated and healed. Two patients underwent radiation therapy and 1 died before starting radiation due to other unnatural causes. The 2 patients achieved perfect oral sphincter competence without drooling and at 9 months postoperative demonstrated successful reinnervation of the vastus lateralis muscle.

CONCLUSIONS

This study demonstrates that lip reconstruction using an innervated vastus lateralis muscle free flap is a reliable method, providing a functional lip.

Fusuma Sliding Flap for Lip Reconstruction of Lower Lip Cancer

Lower lip cancer is typically treated with surgical excision, and this frequently results in a large defect and severe aesthetic problems. Local flap reconstruction is suitable for restoring appearance and function, and it causes less surgical stress than a vascularized free flap. The Fusuma sliding flap is a local flap technique introduced by Kasai et al in 2008. Here, the authors report their use of this method for lip reconstruction in a 94-year-old Japanese female after the removal of a cancerous mass.

Autologous Ear Reconstruction for Microtia Does Not Result in Loss of Cutaneous Sensitivity

BACKGROUND

Cutaneous sensitivity of microtia reconstruction has been sparsely documented. The purpose of this study was to evaluate whether there is a loss of cutaneous sensitivity following two-stage autologous ear reconstruction for unilateral microtia.

METHODS

A prospective study was performed including unilateral microtia patients who underwent two-stage autologous ear reconstruction performed by a single plastic surgeon between 2011 and 2016. Standardized sensory testing (i.e., temperature discrimination and Semmes-Weinstein monofilaments) was executed at 11 predefined anatomical points of the affected and unaffected ears preoperatively and at 6 and 12 months postoperatively.

RESULTS

Thirty-eight patients were included. Affected and unaffected sides presented similar (all p > 0.05) preoperative cutaneous sensitivity. Most (72.7 percent) of the tested points showed (all p < 0.05) preservation or recovery of cutaneous sensitivity at 12 months postoperatively. When comparing the reconstructed ears with the unaffected ears, there was no significant difference (all p > 0.05) in most (72.7 percent) of the tested points, except (all p < 0.05) at those points involving the postauricular sulcus.

CONCLUSION

There is a temporary cutaneous sensitivity loss after a two-stage autologous microtia reconstruction, which returned to similar preoperative sensitivity at 12-month follow-up, except in the postauricular sulcus.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.