Wave technique for treatment of lower lip cancer

Submandibular artery: bilobed platysma myocutaneous flap for total lower lip reconstruction

BACKGROUND

Lower lip reconstruction following cancer resection includes a variety of clinical and microsurgical options.

OBJECTIVE

We have developed a myocutaneous flap for full thickness reconstruction with a functioning muscle.

TECHNIQUE

In all patients, the submandibular artery was outlined using computerized tomographic angiography and Doppler. The flap was designed after resection. The first lobe was designed to fill the defect and was outlined 90° from the defect margin, with the submandibular artery in the center of the flap. A second lobe was then outlined 90° from the first lobe. The flap was raised along with the platysma muscle and artery, with the first lobe rotated to the lip and the second lobe inset into the first lobe site, permitting neck closure without skin redundancy.

RESULTS

From January to May 2012, 17 patients were treated with this flap, and all flaps survived. All of the patients had oral continence at sixteen months, and electromyography documented platysma function.

CONCLUSION

The flap provides single-stage lower lip reconstruction with functional muscle.

Total lower lip reconstruction with a double mental neurovascular V-Y island advancement flap

PURPOSE

To assess the effectiveness of double mental V-Y island advancement flaps for total lower lip reconstructions.

MATERIALS AND METHODS

During a 6-year period, from 2006 to 2012, total lower lip reconstruction was performed in 12 patients using double mental V-Y island advanced flaps. The resulting lip function and superiority of each flap were analyzed. To assess any cosmetic implications, patients were asked to answer the Appearance Domain section from the University of Washington Quality of Life Questionnaire at least 12 months after discharge from the hospital.

RESULTS

All flaps survived completely and no short-term postoperative complications occurred. The mean follow-up time was 34.5 months (range, 15 to 69 months) and there was no recurrence of disease. All patients were capable of consuming a regular oral diet and no patients complained of an inability to eat in a public setting, drooling, or microstomia. The mean preoperative and postoperative open-mouth widths were 4.1 and 3.7 cm, respectively, and the mean reduced open-mouth width was 10%. The intercommissural width varied from 4.6 to 6.8 cm (mean, 5.5 cm). The mean postoperative 2-point discrimination was 11.2 mm (range, 9 to 13 mm). The mean score for the Appearance Domain section was 93.8 (range, 75 to 100).

CONCLUSION

The mental V-Y island advancement flap reconstruction is a reliable procedure for total lower lip reconstruction.