Nasolabial and forehead flap reconstruction of contiguous alar-upper lip defects

Scalp Composite Tissue Transplantation for Repairing Upper Lip Defect: A Feasible Clinical Study

BACKGROUND

The repair of upper lip defects is difficult and can result in asymmetry. The authors have developed a postauricular scalp composite tissue for the repair of upper lip defects. Herein, the authors, present the feasibility of scalp composite tissue grafts for repairing of upper lip defects.

METHODS

The authors conducted a retrospective study of 10 patients who underwent scalp composite tissue transplantation for upper lip repair. The surgical procedure consisted of the excision of skin lesions or scar tissue from the upper lip to prepare the recipient area, and then the scalp composite tissue was excised behind the ear and transplanted to the upper lip defect. The authors reviewed the photographs and clinical notes of these patients. The patients' self-reported satisfaction with the repair effect was assessed. Tissue sections and hematoxylin and eosin staining of the scalp composite tissues were performed.

RESULTS

All patients successfully underwent lesion resection and scalp composite tissue transplantation to repair the wound. There was no necrosis of the scalp composite tissue in the early postoperative period. The lip wound healed completely within 2 weeks. The mean follow-up time was 16 months, ranging from 12 to 20 months. Histologic sections and hematoxylin and eosin staining showed that the scalp composite tissue had abundant capillaries and dense fibrous connective tissue. All 10 patients were satisfied with the clinical effect of the procedure.

CONCLUSION

Scalp composite tissue transplantation is a viable method for repairing upper lip defects. The special histomorphological characteristics of the scalp provide the basis for clinical application.

LEVEL OF EVIDENCE

IV.

Upper lateral lip flap for the coverage of large superficial labial defect

BACKGROUND

Reconstruction of large superficial defects of the upper lip is challenging, as it requires the restoration of both function and morphology. To achieve optimal results, facial features and landmarks should be preserved and similar skin should be used. Moreover, in male patients, upper lip pilosity should be restored. Although myriad of local flaps have previously been described, few address these issues. Herein, we describe our results with an upper lateral lip rotation flap for large upper lip cutaneous defects coverage.

PATIENTS AND METHOD

A retrospective study was performed including every patient who underwent an upper lateral lip flap between 2010 and 2017. Demographic data, defect dimensions, etiology, type of anesthesia, operative time, postoperative complications, functional and morphological outcomes were recorded.

RESULTS

A total of 31 patients were included. All procedures were performed under local anesthesia as outpatient procedures. The length of the operative procedure was 48minutes in average. The mean size of the superficial defect was 19mm (ranging from 6 to 30mm). All patients were fully healed after 15 days, and no flap necrosis (partial or total) was reported. No nasal or lip distortion was observed and facial hair was successfully restored in all male patients.

CONCLUSION

The upper lateral lip flap is a fast, safe, and reproducible procedure to cover defects of the lateral upper lip of up to 3cm. With scars hidden in natural folds and lip defects covered by lip tissues, this technique restores facial cosmetic features with very satisfying aesthetic outcome, especially in men as facial hair is restored.

Reconstruction of Facial Defects with Three-Stage Frontal Expanded Bipedicled Flaps

BACKGROUND

The aim of the present study was the therapeutic effect of the frontal expanded bipedicled flaps that are used in the reconstruction of facial defects. Patients were treated with mostly unilateral facial defects which affected temple area and cross the midline with frontal expanded flaps to investigate the therapeutic effect of reconstruction of facial defects with frontal expanded bipedicled flaps from June 2012 to August 2017 and 2 patients were discussed in this study.

METHODS

The surgery procedure was divided into 3 stages. At the first stage, expanders were implanted and the expanded frontal flaps were transferred at second stage. After that pedicle division was performed and the pedicle skin tissue was used to repair the residue defect at the third stage.

RESULTS

All 7 flaps survived completely with satisfactory color and texture. Satisfied results were achieved during the follow-up period of 1 year.

CONCLUSION

The bipedicled frontal expanded flap is very suitable for large facial defect due to its reliable blood supply.

[Application of local skin flaps in adjustment of reconstructed nasal alars at second stage]

Objective

To investigate the effectiveness of local skin flaps such as V-Y advancement flap (V-Y plasty) and transposition flap (Z plasty) in the adjustment of reconstructed nasal alars at second stage.

Methods

Between June 2012 and January 2017, 14 cases of reconstructed nasal alars by nasolabial flap or expanded forehead flap were recruited. There were 9 males and 5 females with an average age of 34.8 years (range, 18-52 years). The interval time between one- and two-stage operations was 1-12 months (mean, 3 months). The type of local skin flap was decided according to the flaws of reconstructed nasal alars. V-Y plasty was used in 5 cases, Z plasty in 2 cases, and V-Y plasty combined with Z plasty in 7 cases.

Results

All operations were successfully completed. The flaps in 3 cases suffered from epidermal necrosis at the far end and healed by dressing change. The other wounds healed by first intention. All 14 cases were followed up 6-40 months (mean, 12 months). The nasal alars had verisimilar shape and symmetrical appearance. The color and texture of reconstructed nasal alar were closed to peripheral tissues.

Conclusion

Applying local skin flaps such as V-Y plasty and Z plasty can acquire a better shape in the adjustment of reconstructed nasal alars.