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Muller JN, Diaz A, Flores RL, Staffenberg DA. Abbe Flap Division Before Two Weeks' Time: Harmful or Advantageous? Cleft Palate Craniofac J 2024:10556656231223615. [PMID: 38166385 DOI: 10.1177/10556656231223615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024] Open
Abstract
INTRODUCTION The Abbe flap is a standard intervention to treat upper lip deformities in patients with bilateral cleft lip. This two-stage procedure requires a 2 to 3-week period in which the superior and inferior lips remain connected. This study evaluates the safety of Abbe flap division and inset prior to 14 days' time. MATERIALS AND METHODS A single institution, 8-year review of all patients with a bilateral cleft lip who underwent Abbe flap reconstruction was performed. Patients were classified into two groups: those whom division was performed 14 days or later and those with division earlier than 14 days. RESULTS A total of 26 patients were identified. Patients who underwent Abbe flap division in less than 14 days (n = 10) demonstrated an average time to division of 9.7 days (range 7-13 days) with no evidence of flap loss, wound breakdown or infection. Patients who underwent Abbe flap division within 14 days or more (n = 16) demonstrated an average time to division of 15 days with four minor complications and no flap loss. CONCLUSION Dividing the Abbe flap after the first postoperative week appears to be safe and without additional risk to flap loss or wound breakdown. A shorter time to Abbe flap division may decrease the burden of care on patients and their caregivers.
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Affiliation(s)
- John N Muller
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, 10016, USA
| | - Allison Diaz
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, 10016, USA
| | - Roberto L Flores
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, 10016, USA
| | - David A Staffenberg
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, 10016, USA
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2
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Kromer CM, Jefferson J, Crowe D, Knackstedt T. Outcomes of Upper Lip Mohs Surgery Repairs Using Standardized Scar Scales With Particular Emphasis on Vermillion Border Involvement. Dermatol Surg 2023; 49:1085-1090. [PMID: 37712745 DOI: 10.1097/dss.0000000000003918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
BACKGROUND The lips are a common location for skin cancer, and thus, a common site for Mohs micrographic surgery (MMS). As an important cosmetic and functional facial unit, MMS defects and reconstruction can affect patient perception on functional and aesthetic outcomes. OBJECTIVE The objective of this study was to compare aesthetic and functional outcomes after upper lip MMS between patients with vermillion sparing repairs (VSR) versus vermillion crossing repairs (VCR). MATERIALS AND METHODS Patients from a single institution from 2018 to 2022 undergoing MMS of the upper lip with linear or select flap repairs were included. Patients were assessed at a minimum of 6-week follow-up for self-assessment of functional and cosmetic outcomes, as well as physician assessment of scar cosmesis using validated Patient and Observed Scar Assessment Scale and Scar Cosmesis Assessment and Rating scale. The results were compared between VSR and VCR groups. RESULTS Forty-five patients were included in this study. No significant difference between patient assessment of functional and cosmetic outcome was identified between VSR and VCR. CONCLUSION Patient satisfaction with lip reconstruction can be high. Crossing the vermillion border does not affect patient assessment of aesthetic and functional results and should be considered if needed to optimize reconstructive outcomes.
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Affiliation(s)
| | | | | | - Thomas Knackstedt
- Mohs Surgery Unit, Pinehurst Dermatology and Mohs Surgery Center, Pinehurst, North Carolina
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina
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Jaganathan BK, Kumar SB. A Novel Technique to Convert Static Sling into a Dynamic Sling in Reconstruction of Total Lower Lip Defects Using Palmaris Longus Tendon with Free Radial Forearm Flap and Case Series. Indian J Otolaryngol Head Neck Surg 2023; 75:1981-1985. [PMID: 37636679 PMCID: PMC10447804 DOI: 10.1007/s12070-023-03789-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/07/2023] [Indexed: 08/29/2023] Open
Abstract
Lower lip reconstruction has been a major challenge for the reconstructive surgeons since time immemorial. Various types of reconstruction had been described for the reconstruction of lower lip ranging from local flaps to free tissue transfer to free functioning muscle transfer. For complete lower lip defects, the free radial forearm flap with palmaris longus tendon has been the standard of reconstruction for many years. Literatures suggests various techniques for utilizing palmaris longus tendon sling as a static as well as dynamic structure. The limitation with static reconstruction is the loss of sling support with time leading to eversion and drooping of the reconstructed lower lip and drooling of saliva. In this article we describe a simpler and novel technique which converts static reconstruction into a dynamic one with a series of 5 patients. Aim of this prospective study was to evaluate the post operative functional and aesthetic outcome of our technique of total lower lip reconstruction using free radial forearm flap with palmaris longus sling reconstruction. The medical records included were demographics, including age, gender, and reason for the acquired defect, lip reconstructed, reconstructive method, flap survival, and outcomes. At 6 months follow up, all patients had satisfactory outcome and were able to take oral diets and none of the patients complained of drooling, an inability to eat in a public setting, or microstomia. This technique which is a simpler modification can be helpful in converting the traditional static sling reconstruction of lower lip into a dynamic one resulting in good aesthetic and functional outcomes.
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Affiliation(s)
- Balaji K. Jaganathan
- Department of Plastic and Reconstructive surgery, Apollo Hospitals, 21 Greams Lane, Thousand Lights, Chennai, Tamil Nadu 600006 India
| | - Sashi Bhushan Kumar
- Department of Plastic and Reconstructive surgery, Apollo Hospitals, 21 Greams Lane, Thousand Lights, Chennai, Tamil Nadu 600006 India
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Reece MK, Angermayer M, Noel T, Johnson RM, Kadakia S. Intraoral nasolabial flap for lower lip augmentation following post-radiation contracture. Am J Otolaryngol 2023; 44:103703. [PMID: 36495647 DOI: 10.1016/j.amjoto.2022.103703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 11/26/2022] [Indexed: 12/12/2022]
Abstract
The nasolabial flap (NLF) has been reported extensively for reconstruction of various intraoral and extraoral defects resulting from trauma or ablative surgery. However, it has not been described for post-radiation lip augmentation. Herein, we present the case of a 74-year-old female who previously underwent a subtotal glossectomy and free flap reconstruction followed by radiotherapy. While oncologically the patient did well, she developed a significant lower lip contracture which compromised oral intake, denture placement, lip excursion, and psychosocial well-being. The patient underwent release of the scar contracture and a NLF was utilized intraorally to act as a spacer between the gingiva and inner lip mucosa to augment the soft tissue deficit. The patient went on to regain oral intake and placement of her dentures, while reporting significant satisfaction with the post-procedural benefits.
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Affiliation(s)
- Mac Kenzie Reece
- Wright State University Boonshoft School of Medicine, Department of Surgery, Dayton, OH, United States of America.
| | - Megan Angermayer
- Wright State University Boonshoft School of Medicine, Department of Plastic Surgery, Dayton, OH, United States of America.
| | - Tiffany Noel
- Wright State University Boonshoft School of Medicine, Dayton, OH, United States of America.
| | - R Michael Johnson
- Department of Plastic and Reconstructive Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, United States of America
| | - Sameep Kadakia
- Department of Plastic and Reconstructive Surgery, Wright State University Boonshoft School of Medicine, 30 E Apple St, Suite 2200, 45409 Dayton, OH, United States of America.
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5
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Tsai CS, Chang CC, Hsiao JR. Inferiorly based nasolabial flap for reconstruction of full-thickness medium-sized lower lip and commissural defects following ablative cancer surgery. J Chin Med Assoc 2022; 85:1083-1087. [PMID: 36343273 DOI: 10.1097/jcma.0000000000000805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Information regarding the design and usage of inferiorly based nasolabial flap for lower lip and commissural defect reconstruction following ablative cancer surgery remains limited. This study aimed to provide our design and experiences for such reconstructive purpose. METHODS Patients with lower lip or oral commissural cancer who received curative surgery involving reconstruction with inferiorly based nasolabial flap were included. The demographic data and clinical outcomes of these patients were obtained by retrospective chart review. RESULTS A total of eight patients were enrolled in this study. All patients received ablative surgery at the National Cheng Kung University Hospital during May 2019 to May 2021, with their surgical defects reconstructed with unilateral inferiorly based nasolabial flap successfully. Among the five patients with lower lip cancer, one had a limited area of necrosis at flap tip. Another patient had a small orocutaneous fistula that healed spontaneously. No trismus or oral incompetence was noted following recovery. For the three patients with commissural cancer, a second stage commisuroplasy was needed after primary reconstruction. One patient had limited wound dehiscence at mouth angle following surgery, resulting in mild oral incompetence. Although mild trismus was noted in these three commissural cancer patients, all patients resumed normal diet during follow-up. CONCLUSION Inferiorly based nasolabial flap is an excellent local flap for lower lip reconstruction following cancer ablative surgery. It is also a viable option for reconstruction of oral commissural defects. Minimal donor side morbidity, good functional recovery, and esthetic outcomes can be achieved with meticulous flap design.
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Affiliation(s)
- Chien-Sheng Tsai
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
| | - Chan-Chi Chang
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
| | - Jenn-Ren Hsiao
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
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Pradhan P, Pradhan S, Samal DK. Infolding of Nasolabial Flap: An Excellent Surgical Technique for Full-Thickness Defect of the Lip. Indian J Otolaryngol Head Neck Surg 2022; 74:2589-2592. [PMID: 36452594 PMCID: PMC9702155 DOI: 10.1007/s12070-020-02274-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/09/2020] [Indexed: 11/24/2022] Open
Abstract
To find out the usefulness of the infolding technique of nasolabial flap to reconstruct full-thickness defects of the lower lip. It is a retrospective analysis of 5 surgically operated cases. The infolding nasolabial flaps were utilized for the full thickness defect over the lower lip in carcinoma of the oral cavity from January 2018 to July 2019. The patients were followed up for a minimum period of 12 months, and the outcomes were evaluated. The mean age of the patients was 39.72 ± 7.58 years (range 30-52 years). The infolding nasolabial flap has used each case for the reconstruction of the lower lip. The average length and breadth of the flaps were 65 mm (range 60-75 mm) and 35 mm (range 30-40 mm), respectively. One patient presented with partial necrosis of the flap its tip. The functional and cosmetic outcomes were found satisfactory till 12 months of follow-up, and none of the patients had a recurrence of the disease. Infolding of the nasolabial flap can be a good surgical technique for the reconstruction of the full-thickness defect of the lower lip, ensuring satisfactory functional and cosmetic outcomes without causing major intraoperative/postoperative complications in patients with carcinoma of the lower lip.
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Affiliation(s)
- Pradeep Pradhan
- Department of ENT and Head Neck Surgery, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha 751019 India
| | - Sidharth Pradhan
- Department of ENT and Head Neck Surgery, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha 751019 India
| | - Dillip Kumar Samal
- Department of ENT and Head Neck Surgery, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha 751019 India
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Mishra A, Shankar R, Prakash G, Banerjee S, Daga D, Birmiwal KG, Tiwari N, Gupta M, Sahu GC, Das A. Transposition nasolabial flap: A versatile flap for sensate reconstruction of lip defects. Head Neck 2022; 44:2473-2480. [PMID: 35920377 DOI: 10.1002/hed.27164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 07/03/2022] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Lip reconstruction aims at maintaining the function and aesthetics of the facial subunits. Sensation in the reconstructed lip helps in bolus formation, tactile discrimination, and thermal sensation. In this study, we aim to describe random pattern nasolabial flap for lip reconstruction using various functional parameters. METHODOLOGY This is a retrospective study of 22 patients with carcinoma lip who underwent surgical resection and reconstruction with sensate nasolabial flap. Several clinicopathological parameters were studied. Outcome parameters like oral competence, tactile sensation, thermal sensitivity of reconstructed lip and speech outcomes were evaluated. RESULT A functional outcome with 2-4 mm of two-point discrimination was obtained in 19 patients. All patients had intelligible speech. A mean sulcus depth of 19.59 mm was achieved. One patient had partial flap loss owing to wound infection. CONCLUSION Random pattern senate nasolabial flap offers a good functional outcome by maintaining the tactile and thermal sensitivity.
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Affiliation(s)
- Aseem Mishra
- Department of Surgical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre and Tata Memorial Centre, Varanasi, India
| | - Ravi Shankar
- Department of Surgical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre and Tata Memorial Centre, Varanasi, India
| | - Gautam Prakash
- Department of Plastic Surgery and Burns Unit, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Sudeshna Banerjee
- Department of Surgical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre and Tata Memorial Centre, Varanasi, India
| | - Dipti Daga
- Head and Neck Oncology, Netaji Subash Cancer Hospital, Kolkata, India
| | - Krishna Gopal Birmiwal
- Department of Head and Neck Oncology, Acharya Harihar Post Graduate Institute of Cancer, Cuttack, India
| | - Neelesh Tiwari
- Department of Surgical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre and Tata Memorial Centre, Varanasi, India
| | - Monika Gupta
- Department of Surgical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre and Tata Memorial Centre, Varanasi, India
| | - Guru Charan Sahu
- Department of Surgical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre and Tata Memorial Centre, Varanasi, India
| | - Abhishek Das
- Department of Surgical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre and Tata Memorial Centre, Varanasi, India
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8
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Reconstruction of Subtotal Defect of the Lower Lip: Combined Use of Karapandzic and Nasolabial Flap. Indian J Otolaryngol Head Neck Surg 2022; 74:116-120. [PMID: 35070933 PMCID: PMC8743317 DOI: 10.1007/s12070-020-02205-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022] Open
Abstract
Subtotal reconstruction of the lower lip after excision of the tumor is always a challenge for surgeons. It is because of the difficulty in regaining the function of the lip, including the oral competency and restoring the aesthetic subunit. A 46-year-old patient presented with an ulceroproliferative growth involving 70% of the lower lip, including the right commissure. After the confirmation to be a malignancy, patient underwent excision of the tumour and reconstruction of the lower lip using the left Karapandzic flap and right nasolabial flap. The patient was on regular follow-up in the postoperative period to assess the surgical outcomes. The combined use of Karapandzic flap and the nasolabial flap can be reliably used for subtotal reconstruction of the lower lip in advanced oral cavity malignancy, involving one of the commissures. Later can ensure good postoperative results in terms of aesthetic and functional lip reconstruction without any significant intraoperative or postoperative complications.
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9
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Depani M, Ferry AM, Grush AE, Moreno TA, Jones LM, Thornton JF. Use of Biologic Agents for Lip and Cheek Reconstruction. Semin Plast Surg 2022. [DOI: 10.1055/s-0042-1742747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractThe unique requirements of reconstructing cheek defects, often with its proximity to the mobile elements of the face including the lip and the eyelid, have been met very handily with the directed and thoughtful use of biologic wound healing agents. One of the key advantages of these agents is their ability to provide coverage for the mobile elements of the cheek and the lip in patients with multiple co-morbidities. These agents are successfully used where the standard cheek closure techniques including cervicofacial advancement flap are contraindicated due to its anesthetic requirement. Additionally, lip reconstruction involves examining the lip's three anatomic layers: mucosa, muscle, and skin. The defects must be planned for reconstruction based on the involvement of these layers. This paper serves to introduce the use of biologic wound healing agents depending on the involvement of these layers. The authors provide specific illustrations of these agents based on defect location, tissue involvement, and severity of the defect to help with procedural planning to reconstruct a very aesthetically involved part of the face.
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Affiliation(s)
- Monal Depani
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Andrew M. Ferry
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Andrew E. Grush
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Tanir A. Moreno
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Lloyd M. Jones
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - James F. Thornton
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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10
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Depani M, Ferry AM, Grush AE, Moreno TA, Jones LM, Thornton JF. Use of Biologic Agents for Lip and Cheek Reconstruction. Semin Plast Surg 2021; 36:26-32. [PMID: 35706563 PMCID: PMC9192158 DOI: 10.1055/s-0041-1741399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The unique requirements of reconstructing cheek defects, often with its proximity to the mobile elements of the face including the lip and the eyelid, have been met very handily with the directed and thoughtful use of biologic wound healing agents. One of the key advantages of these agents is their ability to provide coverage for the mobile elements of the cheek and the lip in patients with multiple co-morbidities. These agents are successfully used where the standard cheek closure techniques including cervicofacial advancement flap are contraindicated due to its anesthetic requirement. Additionally, lip reconstruction involves examining the lip's three anatomic layers: mucosa, muscle, and skin. The defects must be planned for reconstruction based on the involvement of these layers. This paper serves to introduce the use of biologic wound healing agents depending on the involvement of these layers. The authors provide specific illustrations of these agents based on defect location, tissue involvement, and severity of the defect to help with procedural planning to reconstruct a very aesthetically involved part of the face.
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Affiliation(s)
- Monal Depani
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Andrew M. Ferry
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Andrew E. Grush
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Tanir A. Moreno
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Lloyd M. Jones
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - James F. Thornton
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas,Address for correspondence James F. Thornton, MD Department of Plastic Surgery, University of Texas Southwestern Medical Center1801 Inwood Road, Dallas, TX 75390-9132
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11
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The Use of Vastus Lateralis Muscle Flap for Functional Lip Reconstruction. J Craniofac Surg 2021; 33:1566-1568. [PMID: 34816817 DOI: 10.1097/scs.0000000000008345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/17/2021] [Indexed: 11/25/2022] Open
Abstract
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.
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Frohwitter G, Lutz R, Baran C, Weber M, Nobis CP, Rau A, Kesting M. Consistent Value of Two-Stage Pedicle Flaps in the Age of Microsurgical Maxillofacial Reconstruction. J Maxillofac Oral Surg 2021; 22:98-104. [PMID: 37041957 PMCID: PMC10082879 DOI: 10.1007/s12663-021-01635-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 08/10/2021] [Indexed: 11/29/2022] Open
Abstract
Abstract
Introduction
Up to the second half of the twentieth century, pedicled flaps marked the gold standard in reconstructive surgery. Followed by the introduction of microsurgical techniques, these flaps were increasingly abandoned. We conducted a retrospective study to determine the value of two-stage pedicle flaps in modern maxillofacial reconstruction.
Material & Methods
A chart review from October 2017 to November 2020 was performed to identify patients who were treated by a two-stage pedicle flap in our Department of Oral and Maxillofacial Surgery.
Results
A total of 31 patients, 17 female and 14 males received 36 two-stage pedicle flaps. All patients were in noticeably impaired health condition with a majority of ASA-score 3. The defect location mainly contained extraoral resections (58.3%). A variety of flaps were harvested consisting of buccal flaps, Abbe flaps, forehead flaps, deltopectoral flaps, nasolabial flaps, and a tubed flap.
Discussion
The study outlines two indications for the use of two-stage pedicle flaps. Firstly, as a back-up strategy in heavily pre-treated wound beds and secondly in an almost contrarily indication as a first-choice reconstructive option of the facial skin in esthetic demanding cases.
Conclusion
The timesaving and straight forward surgical approach as well as their low postsurgical complications and strong long-time success rates secure the two-stage pedicle flap a justified niche role in times of microsurgical maxillofacial reconstruction.
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Affiliation(s)
- G Frohwitter
- Department for Oral and Maxillofacial Surgery, University Hospital Erlangen, Glueckstrasse 11, 91054 Erlangen, Germany
| | - R Lutz
- Department for Oral and Maxillofacial Surgery, University Hospital Erlangen, Glueckstrasse 11, 91054 Erlangen, Germany
| | - C Baran
- Department for Oral and Maxillofacial Surgery, University Hospital Erlangen, Glueckstrasse 11, 91054 Erlangen, Germany
| | - M Weber
- Department for Oral and Maxillofacial Surgery, University Hospital Erlangen, Glueckstrasse 11, 91054 Erlangen, Germany
| | - C P Nobis
- Department for Oral and Maxillofacial Surgery, University Hospital Erlangen, Glueckstrasse 11, 91054 Erlangen, Germany
| | - A Rau
- Department for Oral and Maxillofacial Surgery, University Hospital Greifswald, Greifswald, Germany
| | - M Kesting
- Department for Oral and Maxillofacial Surgery, University Hospital Erlangen, Glueckstrasse 11, 91054 Erlangen, Germany
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13
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Abstract
ABSTRACT Facial trauma can pose challenging reconstructive obstacles in both maintaining tissue viability and restoring aesthetic appearance. Medicinal leech therapy can help to promote vascular decompression in the setting of venous congestion. A retrospective chart review was conducted to identify patients who underwent medicinal leech therapy following venous stasis secondary to repair of a complex facial laceration. Three patients were identified; 2 suffered auricular avulsion, while 1 suffered a lip avulsion. All patients suffered from venous congestion and underwent medicinal leech therapy for 48 to 72 hours with reduction of edema and stasis. Decompression was successfully achieved with no further sequelae on last follow-up. Medicinal leech therapy is an adequate treatment for venous congestion following traumatic soft-tissue repair of the face. The authors advocate for the utilization of medicinal leeches to combat venous congestion after repair, particularly when arterial inflow remains intact.
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Dadhich A, Shah S, Nilesh K, Saluja H, Girhe V, Agarwal S, Mishra M. Reconstruction of acquired lip defects: Ten-year experience at a tertiary care center. J Oral Biol Craniofac Res 2020; 10:698-704. [PMID: 33072507 DOI: 10.1016/j.jobcr.2020.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/26/2020] [Indexed: 11/17/2022] Open
Abstract
Aim The purpose of this paper is to describe different acquired conditions necessitating lip reconstruction and present our ten-years' experience in managing the same at a tertiary care hospital. Materials and methods Data of patients undergoing reconstruction of acquired lip defects from January 2009 to December 2019 were analyzed for demographic details, etiology, extent of defect, reconstruction option used, outcome and complications. Results 89 patients underwent lip reconstruction after excision of malignant tumors (81%), vascular malformations (12%) and traumatic injuries (7%). Mucosal and cutaneous lip defects were seen in 8 (9%) and 3 (3%) patients respectively, which were treated by primary closure, local advancement flap and tongue flap. Full thickness defects involving less than 1/3rd of lip (36%) and involving up to 2/3rd of lip (33%) were treated by primary closure, Abbe, Abbe Estlander flap and Karapenzic, Bernard Webster & peri-alar crescentic flaps respectively. Sub-total lip defects were repaired using distant and free vascularized flaps. All the localized cutaneous/mucosal defect repair healed uneventfully. Complications associated full thickness defect reconstruction included reduced stoma, flap necrosis and hypertrophic scar. Conclusions Repair of localized cutaneous/mucosal defects of lip are simple with no significant documented complication. However, full thickness tissue loss necessities careful surgical planning. The choice of surgical technique depends on the extent of lip length lost. While Karapandzic flap was most commonly utilized to reconstruct lip defect involving up to 2/3rd of the lip, radial forearm flap was a choice in managing subtotal lip tissue loss.
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Affiliation(s)
- Anuj Dadhich
- Department of Oral & Maxillofacial Surgery, Rural Dental College & Hospital, Loni, Maharashtra, India
| | - Seemit Shah
- Department of Oral & Maxillofacial Surgery, Rural Dental College & Hospital, Loni, Maharashtra, India
| | - Kumar Nilesh
- Department of Oral & Maxillofacial Surgery, School of Dental Sciences, KIMSDU, Karad, Maharashtra, India
| | - Haish Saluja
- Department of Oral & Maxillofacial Surgery, Rural Dental College & Hospital, Loni, Maharashtra, India
| | - Vijaykuamar Girhe
- Dept. of Oral and Maxillofacial Surgery, Hedgewar Smruti Dental College, Hingoli, Maharashtra, India
| | | | - Madan Mishra
- Dept. of Oral & Maxillofacial Surgery, Sardar Patel Dental College, Luckhnow, Uttar Pradesh, India
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Evaluating the Anatomical Traits of Lip on Three-Dimensional Computed Tomography Images. J Craniofac Surg 2020; 31:e163-e166. [PMID: 31934969 DOI: 10.1097/scs.0000000000006124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Lips and mouth are the most recognizable parts of the lower face. The morphometry of the facial organs is important for the balance of the face. Besides congenital anomalies occur on the lips, some kinds of deformities might be seen because of trauma or carcinoma. In this respect, lips are in the study of plastic surgery, maxillofacial surgery and orthodontics. Lip morphology also takes an important role in forensic facial reconstruction (facial approximation). MATERIALS AND METHODS Twenty parameters on the soft tissue and 12 parameters on the hard tissue were measured on three dimensional (3D) computed tomography (CT) images belonging 50 individuals (25 female, mean age 35.40 ± 9.97; 25 male, mean age 34.32 ± 11.06). RESULTS Statistical significance was observed on 4 parameters measured at soft tissue and 6 parameters measured in hard tissue. Statistical significance was not seen between the measurements taken bilaterally. Fourteen equations were developed in order to estimate the lip morphometry using the morphometric traits of hard tissue. CONCLUSION We hope that the results of current study will be useful at surgery and forensic sciences.
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Ouhayoun L, Madar Y, Chatel H, Benoilid M, Tresallet C, Quilichini J. Upper lateral lip flap for the coverage of large superficial labial defect. ANN CHIR PLAST ESTH 2020; 66:159-166. [PMID: 32654842 DOI: 10.1016/j.anplas.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/16/2020] [Accepted: 05/28/2020] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- L Ouhayoun
- Department of plastic and reconstructive surgery, Robert-Ballanger hospital, 93600 Aulnay-sous-Bois, France.
| | - Y Madar
- Department of plastic and reconstructive surgery, Robert-Ballanger hospital, 93600 Aulnay-sous-Bois, France
| | - H Chatel
- Department of plastic and reconstructive surgery, Robert-Ballanger hospital, 93600 Aulnay-sous-Bois, France
| | - M Benoilid
- Department of plastic and reconstructive surgery, Robert-Ballanger hospital, 93600 Aulnay-sous-Bois, France
| | - C Tresallet
- Paris XIII university, Avicenne hospital, university hospital Paris Seine Saint Denis (HUPSSD), Assistance publique-Hôpitaux de Paris (AP-HP), 125, boulevard de Stalingrad, 93000 Bobigny, France; Faculté de médecine Paris XIII, université Sorbonne Paris Nord, Bobigny, France
| | - J Quilichini
- Department of plastic and reconstructive surgery, Robert-Ballanger hospital, 93600 Aulnay-sous-Bois, France; Paris XIII university, Avicenne hospital, university hospital Paris Seine Saint Denis (HUPSSD), Assistance publique-Hôpitaux de Paris (AP-HP), 125, boulevard de Stalingrad, 93000 Bobigny, France; Faculté de médecine Paris XIII, université Sorbonne Paris Nord, Bobigny, France.
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Achieving a Good Aesthetic Result in the Correction of Giant Nevus of the Labiomental Area. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2726. [PMID: 32440403 PMCID: PMC7209834 DOI: 10.1097/gox.0000000000002726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/31/2020] [Indexed: 11/26/2022]
Abstract
Benign skin lesions of the face require appropriate surgical treatment. Giant pigmented skin lesions possess the high risk of malignancy which sometimes is not possible to diagnose preoperatively. Majority of the traditional techniques for lower lip and chin reconstruction were developed for the skin cancer resections and are extensively aggressive and disfiguring in case of benign lesions. Perhaps the less invasive approach based on local skin flaps would lead to better aesthetic and functional outcome. We present a case report of the 67-year-old patient who has passed through numerous unsuccessful attempts of correction of the giant nevus of the chin and lower lip area with continued growth. At the time of our surgery, lesion almost covered the whole chin and lower lip area. Appropriate unaffected skin margins excision was performed, and the defect was addressed with combination of traditional incision patterns with local skin flap technique. We believe that our approach provides a good aesthetic and functional outcome in benign lesions correction of the labiomental area.
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Requirement of the Preservation of Mental Nerve During the Transfer of Depressor Anguli Oris Composite Flap. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2020; 53:256-262. [PMID: 32377092 PMCID: PMC7192271 DOI: 10.14744/semb.2019.04578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/20/2019] [Indexed: 11/20/2022]
Abstract
Objectives Reconstruction of wide lower lip defects is still a challenging subject in terms of obtaining functional and aesthetically acceptable results. Lower lip reconstruction with depressor anguli oris muscle was first described by Tobin in 1983. Since the sensory innervation of this composite muscle flap is provided by the mental nerve, it has been advocated that the mental nerve should be preserve during flap elevation. However, no further study has been conducted about this subject since then. Methods Sixteen patients with lower lip mass have undergone excisional biopsy. The resultant defects were higher than 30% of the total lower lip. All the defects were reconstructed with Depressor anguli oris composite flaps. In 9 of the patients, the mental nerve was preserved and included to the flap, while in remaining patients it was sacrificed. The results were evaluated in terms of sensation, function, and aesthetic appearance. Results In unilaterally reconstructed cases, the results regarding sensation and general complications were similar. However, in bilaterally reconstructed cases, especially where the mental nerve was preserved, the limited arc of rotation has resulted in functional complications, such as whistle deformity in the midline and drooling. Conclusion The mental nerve does not just limit the arc of rotation of the Depressör anguli oris composite flap but also remains as a potential route for metastasis via perineural invasion. Preservation and inclusion of the mental nerve during reconstruction with Depressor anguli oris flap do not provide any superior outcome; on the contrary, these results in various unfavorable events make this flap a poor option. The skin and mucosa of the DAO flap are innervated by the buccal branch of the trigeminal nerve; thus, the mental nerve should not be preserved during surgery.
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Lip Reconstruction after Mohs Cancer Excision: Lessons Learned from 615 Consecutive Cases. Plast Reconstr Surg 2020; 145:533-542. [DOI: 10.1097/prs.0000000000006509] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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20
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Naik A, Griffin M, Szarko M, Butler PE. Optimizing the decellularization process of an upper limb skeletal muscle; implications for muscle tissue engineering. Artif Organs 2019; 44:178-183. [PMID: 31571221 DOI: 10.1111/aor.13575] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 08/05/2019] [Accepted: 09/24/2019] [Indexed: 12/27/2022]
Abstract
Upper limb muscle reconstruction is required following cancer resection, trauma, and congenital deformities. Current surgical reconstruction of the muscle involves local, regional and free flaps. However, muscle reconstruction is not always possible due to the size of the defect and functional donor site morbidity. These challenges could be addressed with the production of scaffolds composed of an extracellular matrix (ECM) derived from decellularized human skeletal muscle. This study aimed to find an optimal technique to decellularize a flexor digitorum superficialis muscle. The first two protocols were based on a detergent only (DOT) and a detergent-enzymatic protocol (DET). The third protocol avoided the use of detergents and proteolytic enzymes (NDNET). The decellularized scaffolds were characterized using qualitative techniques including histological and immunofluorescent staining and quantitative techniques assessing deoxyribonucleic acid (DNA), glycosaminoglycan (GAG), and collagen content. The DOT protocol consisting of 2% SDS for 4 hours was successful at decellularizing human FDS, as shown by DNA content assay and nuclei immunofluorescence staining. The DOT protocol maintained the microstructure of the scaffolds as shown by Masson's trichrome staining and collagen and GAG content. DET and NDNET protocols maintained the ECM, but were unsuccessful in removing all DNA content after two cycles of decellularization. Decellularization of skeletal muscle is a viable option for muscle reconstruction using a detergent only technique for upper limb defects. Further testing in vivo will assess the effectiveness of decellularized scaffolds for upper limb muscle skeletal tissue engineering.
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Affiliation(s)
- Anish Naik
- Division of Surgery, University College London, London, United Kingdom.,Charles Wolfson Center for Reconstructive Surgery, Royal Free Hospital, London, United Kingdom.,Department of Plastic Surgery, Royal Free Hospital, London, United Kingdom
| | - Michelle Griffin
- Division of Surgery, University College London, London, United Kingdom.,Charles Wolfson Center for Reconstructive Surgery, Royal Free Hospital, London, United Kingdom.,Department of Plastic Surgery, Royal Free Hospital, London, United Kingdom
| | - Matthew Szarko
- Division of Surgery, University College London, London, United Kingdom.,Charles Wolfson Center for Reconstructive Surgery, Royal Free Hospital, London, United Kingdom.,Department of Plastic Surgery, Royal Free Hospital, London, United Kingdom
| | - Peter E Butler
- Division of Surgery, University College London, London, United Kingdom.,Charles Wolfson Center for Reconstructive Surgery, Royal Free Hospital, London, United Kingdom.,Department of Plastic Surgery, Royal Free Hospital, London, United Kingdom
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21
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George R, Rajan J, Neralla M, Kumar SP, Haque AE. Modified Bilateral Perialar Crescent Flap for Reconstruction of Combined Upper Lip and Premaxillary Defect. Cureus 2019; 11:e5942. [PMID: 31799084 PMCID: PMC6860699 DOI: 10.7759/cureus.5942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 10/18/2019] [Indexed: 11/05/2022] Open
Abstract
Many reconstruction methods are performed for combined defects of upper lip and premaxilla in oral cancer patients, which are complicated and multiple staged procedures, compromising the functional or structural unit. In this case report, we present a modification of the bilateral perialar crescent flap for reconstructing the combined defect of upper lip and premaxilla in a single stage. A patient diagnosed with well-differentiated squamous cell carcinoma of premaxilla and upper lip, involving a surgical defect of more than one-third but less than two-thirds of the lip underwent two cycles of neoadjuvant chemotherapy. Later wide local excision of the lesion and simultaneous reconstruction with a modified perialar crescent flap was performed in a single stage. Patient recovered uneventfully and tolerated the procedure well, without any complications. The patient was found to be satisfied with the functional and esthetic result. The reduced upper lip support which was a result of the bony defect of the premaxilla, was corrected with a dental prosthesis. This modification is a useful reconstruction tool for oral cancer patients with combined defects of upper lip and premaxilla.
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Affiliation(s)
- Rinku George
- Oncology, Oral Cancer Institute, Saveetha Dental College, Chennai, IND
| | - Jyotsna Rajan
- Oncology, Oral Cancer Institute, Saveetha Dental College, Chennai, IND
| | - Mahathi Neralla
- Oncology, Oral Cancer Institute, Saveetha Dental College, Chennai, IND
| | - Santhosh P Kumar
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospital, Chennai, IND
| | - Ahmed Elham Haque
- Oncology, Oral Cancer Institute, Saveetha Dental College, Chennai, IND
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22
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Farber SJ, Latham KP, Kantar RS, Perkins JN, Rodriguez ED. Reconstructing the Face of War. Mil Med 2019; 184:e236-e246. [DOI: 10.1093/milmed/usz103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/18/2019] [Indexed: 11/14/2022] Open
Abstract
AbstractIntroductionOngoing combat operations in Iraq, Afghanistan, and other theaters have led to an increase in high energy craniomaxillofacial (CMF) wounds. These challenging injuries are typically associated with complex tissue deficiencies, evolving areas of necrosis, and bony comminution with bone and ballistic fragment sequestrum. Restoring form and function in these combat-sustained CMF injuries is challenging, and frequently requires local and distant tissue transfers. War injuries are different than the isolated trauma seen in the civilian sector. Donor sites are limited on patients with blast injuries and they may have preferences or functional reasons for the decisions to choose flaps from the available donor sites.MethodsA case series of patients who sustained severe combat-related CMF injury and were treated at Walter Reed National Military Medical Center (WRNMMC) is presented. Our study was exempt from Institutional Review Board review, and appropriate written consent was obtained from all patients included in the study for the use of representative clinical images.ResultsFour patients treated by the CMF team at Walter Reed National Military Medical Center are presented. In this study, we highlight their surgical management by the CMF team at WRNMMC, detail their postoperative course, and illustrate the outcomes achieved using representative patient clinical images. We also supplement this case series demonstrating military approaches to complex CMF injuries with CMF reconstructive algorithms utilized by the senior author (EDR) in the management of civilian complex avulsive injuries of the upper, mid, and lower face are thoroughly reviewed.ConclusionWhile the epidemiology and characteristics of military CMF injuries have been well described, their management remains poorly defined and creates an opportunity for reconstructive principles proven in the civilian sector to be applied in the care of severely wounded service members. The War on Terror marks the first time that microsurgery has been used extensively to reconstruct combat sustained wounds of the CMF region. Our manuscript reviews various options to reconstruct these devastating CMF injuries and emphasizes the need for steady communication between the civilian and military surgical communities to establish the best care for these complex patients.
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Affiliation(s)
- Scott J Farber
- University of Texas Health Science Center San Antonio, Texas, Division of Plastic and Reconstructive Surgery, 7703 Floyd Curl Drive, MC 7844, San Antonio, TX
| | - Kerry P Latham
- Walter Reed National Military Medical Center Bethesda, MD, Division of Plastic Surgery, 4494 North Palmer Road, Bethesda, MD
| | - Rami S Kantar
- NYU Langone Health New York, NY, Hansjorg Wyss Department of Plastic Surgery, 307 E 33rd Street, New York, NY
| | - Jonathan N Perkins
- Walter Reed National Military Medical Center Bethesda, MD, Department of Otolaryngology-Head & Neck Surgery, 4494 North Palmer Road, Bethesda, MD
| | - Eduardo D Rodriguez
- NYU Langone Health New York, NY, Hansjorg Wyss Department of Plastic Surgery, 307 E 33rd Street, New York, NY
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Uglesic V, Amin K, Dediol E, Kosutic D. Combined Karapandzic–Abbé/Estlander/Stein flap for subtotal and total lower lip reconstruction. J Plast Reconstr Aesthet Surg 2019; 72:484-490. [DOI: 10.1016/j.bjps.2018.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 10/07/2018] [Accepted: 11/11/2018] [Indexed: 11/25/2022]
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Guillemin M, Giran G. Upper lip reconstruction after a dog bite. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2019. [DOI: 10.1051/mbcb/2018029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Observation: In traumatology, wounds of the lips are frequent and their care is often summarized in a suture in one or more planes. Defects at this level are rather rare. When they occur, it is important to study their areas and their size in order to offer the best reconstruction. When Abbes' flap is appropriate, surgical procedure is always achieved remotely from the trauma. Comments: This technique allows rebuilding one-third of the upper lip and gives good functional results and a satisfactory aesthetic result. A weaning of the flap at three weeks, regular follow-up, and prospective surgical revisions will be necessary.
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Anatomical Basis for Lip Reconstruction: The Role of the Modiolus. Ann Plast Surg 2018; 82:565-569. [PMID: 30557180 DOI: 10.1097/sap.0000000000001642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to establish the anatomic basis for functional upper and lower lip reconstruction with locoregional flaps. DESIGN, SETTING, AND PARTICIPANTS This article is an anatomic fresh cadaver study. RESULTS For lower lip reconstruction, the modified Bernard-Webster and Karapandzic flaps preserve the modiolus, buccinator, zygomaticus major muscle, and buccal branches of the facial nerve. The Bernard-Webster flap allowed for a larger oral aperture despite a larger defect, but required transection of the lower lip depressors and orbicularis oris. For upper lip reconstruction, the reverse fan flap preserves the modiolus and its muscle attachments. The reverse Karapandzic flap required transection of the lower lip depressors, buccinator, and the zygomaticus major. CONCLUSIONS AND RELEVANCE Locoregional flaps remain the workhorse for lip reconstruction. This study provides the anatomic basis for the modiolus and its muscular attachments that permit techniques such as the Bernard-Webster flap and the Karapanzic flap to achieve functional lip reconstruction with innervated and denervated tissue.
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A Simple and Innovative Repair Technique for Full-Thickness Defects of Lower Lip. Dermatol Surg 2018; 44:1599-1602. [PMID: 30481163 DOI: 10.1097/dss.0000000000001421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Geelan-Hansen K, Clark JM, Shockley WW. Reconstruction of Defects Involving the Lip and Chin. Facial Plast Surg Clin North Am 2018; 27:67-83. [PMID: 30420074 DOI: 10.1016/j.fsc.2018.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Successful perioral reconstruction is the result of consideration of both functional and esthetic goals. The lips are complex esthetic units with multiple tissue layers and distinct anatomic landmarks. Reconstruction can be difficult due to variables affecting the defect, such as size, depth, location, and involvement of adjacent subunits. There are many local flaps that can be used to match the complex tissue layers and anatomic landmarks. Use of the same reconstructive principles can be applied to secondary reconstruction to attain a successful outcome. This article focuses on local reconstructive options for defects of the lip and chin.
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Affiliation(s)
- Katie Geelan-Hansen
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7070, Chapel Hill, NC 27599, USA.
| | - Joseph Madison Clark
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7070, Chapel Hill, NC 27599, USA
| | - William W Shockley
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7070, Chapel Hill, NC 27599, USA
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30
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Cheng CY, Fang HW. Old Age Lower Lip Cancer Defects Reconstruction by Abbe-Estlander Flap. INT J GERONTOL 2018. [DOI: 10.1016/j.ijge.2018.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Dediol E, Čvrljević I, Dobranić M, Uglešić V. Extended Karapandzic Flap Technique for Reconstruction of Lower Lip and Chin Defect. J Oral Maxillofac Surg 2017; 76:213-220. [PMID: 28697350 DOI: 10.1016/j.joms.2017.06.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/08/2017] [Accepted: 06/09/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE Near total defect of the lower lip adjacent to the chin remains a reconstructive challenge for surgeons in function and esthetics. The objective of this study was to present a modified extended Karapandzic technique for reconstruction of near total defects of the lower lip adjacent with the chin. MATERIALS AND METHODS From 2000 to 2013, patients with lip cancer or oral cavity cancer who required subtotal lower lip and chin resection and subsequently underwent reconstruction with an extended Karapandzic flap were included in this retrospective study. Patient demographics, histopathology, tumor stage, localization, tumor extension, method of reconstruction, and postoperative complications were extracted from patients' documentation. RESULTS Reconstruction of the lower lip and chin was performed in 21 patients using a combination of double local extended Karapandzic flaps with microvascular free flaps for intraoral and mandibular reconstruction. There was no flap necrosis; the main complications were fistula and exposure of the osteosynthesis plate. All lips were functional and the esthetic result was pleasing. All patients returned to a peroral diet, although a variable degree of microstomia was present. CONCLUSION The extended Karapandzic flap technique provides superior results for esthetic and functional lip reconstruction and chin reconstruction compared with any other regional or free flap. Free flaps should be reserved for oral cavity and mandibular reconstruction, if needed.
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Affiliation(s)
- Emil Dediol
- Assistant Professor, School of Medicine, University of Zagreb, Zagreb; Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia.
| | - Igor Čvrljević
- Resident, Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia
| | | | - Vedran Uglešić
- Professor, Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb; Dental School, University of Zagreb, Zagreb, Croatia
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Gundeslioglu AO, Karadag EC, Inan I, Jasharllari L, Selimoglu MN, Guney F, Yuruten B, Bekerecioglu M. Lip reconstruction using a functioning serratus anterior free flap: preliminary study. Int J Oral Maxillofac Surg 2017; 46:1243-1247. [PMID: 28532969 DOI: 10.1016/j.ijom.2017.04.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/22/2017] [Accepted: 04/28/2017] [Indexed: 11/26/2022]
Abstract
Reconstructive surgery to the lips requires the replacement of defective tissues with similarly functioning tissues. While non-dynamic free tissue transfers provide adequate lower lip reconstruction, improved benefits may be obtained with innervated free muscle flaps. This study reports the use of innervated serratus anterior muscle free flaps for lip reconstruction in five patients. All patients had squamous cell carcinoma of either the upper or lower lip. After resection of the tumours, the resultant defects comprised two-thirds of the lips. The innervated serratus anterior muscle free flap was transferred to the lip and an end-to-end vascular anastomosis on the facial artery was performed. The marginal mandibular branch of the facial nerve was preferred for nerve coaptation. The inner and outer surfaces of the flaps were grafted with a split-thickness skin graft. Concentric needle electromyography of the orbicularis oris and frontal muscles was performed for all patients in the preoperative, postoperative, and follow-up periods. All patients survived the surgical operation. Three patients achieved perfect oral sphincter function without drooling. Electromyography at 1 year postoperative demonstrated the successful reinnervation of the serratus anterior muscle. This study demonstrates that lip reconstruction using an innervated serratus anterior muscle free flap is a reliable method, providing a functional lower lip.
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Affiliation(s)
- A O Gundeslioglu
- Department of Plastic, Reconstructive and Aesthetic Surgery, Necmettin Erbakan University, Medical Faculty of Meram, Konya, Turkey
| | - E C Karadag
- Department of Plastic, Reconstructive and Aesthetic Surgery, Necmettin Erbakan University, Medical Faculty of Meram, Konya, Turkey.
| | - I Inan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Necmettin Erbakan University, Medical Faculty of Meram, Konya, Turkey
| | - L Jasharllari
- Department of Plastic, Reconstructive and Aesthetic Surgery, Necmettin Erbakan University, Medical Faculty of Meram, Konya, Turkey
| | - M N Selimoglu
- Department of Plastic, Reconstructive and Aesthetic Surgery, Necmettin Erbakan University, Medical Faculty of Meram, Konya, Turkey
| | - F Guney
- Department of Neurology, Necmettin Erbakan University, Medical Faculty of Meram, Konya, Turkey
| | - B Yuruten
- Department of Neurology, Necmettin Erbakan University, Medical Faculty of Meram, Konya, Turkey
| | - M Bekerecioglu
- Department of Plastic, Reconstructive and Aesthetic Surgery, Necmettin Erbakan University, Medical Faculty of Meram, Konya, Turkey
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33
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Mueller S, Wendl CM, Ettl T, Klingelhöffer C, Geis S, Prantl L, Reichert TE, Jung EM. Contrast-enhanced ultrasonography as a new method for assessing autonomization of pedicled and microvascular free flaps in head and neck reconstructive surgery. Clin Hemorheol Microcirc 2017; 65:317-325. [DOI: 10.3233/ch-16194] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Steffen Mueller
- Department of Cranio-Maxillofacial Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Christina M. Wendl
- Institute of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Tobias Ettl
- Department of Cranio-Maxillofacial Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Christoph Klingelhöffer
- Department of Cranio-Maxillofacial Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Sebastian Geis
- Department of Plastic-, Hand-, and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Lukas Prantl
- Department of Plastic-, Hand-, and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Torsten E. Reichert
- Department of Cranio-Maxillofacial Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Ernst Michael Jung
- Institute of Radiology, University Medical Center Regensburg, Regensburg, Germany
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34
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Upper Lip Reconstruction after Oncologic Resection by a Sliding Advancement Cheek Flap with Buccal Mucosal Eversion. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1100. [PMID: 27975016 PMCID: PMC5142482 DOI: 10.1097/gox.0000000000001100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 08/29/2016] [Indexed: 11/25/2022]
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35
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Charpentier A, Lemperle G. Simultaneous total upper and lower lip reconstruction during a humanitarian surgical mission to Africa. EUROPEAN JOURNAL OF PLASTIC SURGERY 2016. [DOI: 10.1007/s00238-016-1232-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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36
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Meaike JD, Dickey RM, Killion E, Bartlett EL, Brown RH. Facial Skin Cancer Reconstruction. Semin Plast Surg 2016; 30:108-21. [PMID: 27478419 DOI: 10.1055/s-0036-1584821] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Nonmelanoma skin cancers are the most common skin cancers in the United States and the most common malignancies afflicting the head and neck region. Reconstruction of resulting defects has significant aesthetic and functional implications, and plastic surgeons are frequently consulted for reconstruction. Reconstruction can be accomplished via a multitude of approaches spanning the reconstructive ladder, and the approach should be individualized based upon both patient-related and defect-related factors. Here the authors propose a simplified approach to facial reconstruction broken down by aesthetic region.
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Affiliation(s)
- Jesse D Meaike
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
| | - Ryan M Dickey
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
| | - Elizabeth Killion
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
| | - Erica L Bartlett
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
| | - Rodger H Brown
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
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37
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Rajmohan S. Ian's modification of the classic V excision for reconstruction of the lower lip. Br J Oral Maxillofac Surg 2016; 54:228-9. [PMID: 26777096 DOI: 10.1016/j.bjoms.2015.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 12/08/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Susmitha Rajmohan
- Department of Oral and Maxillofacial Surgery, Sri Aurobindo College of Dentistry, Indore, 453111, Madhya Pradesh, India.
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38
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Coutinho I, Ramos L, Gameiro AR, Vieira R, Figueiredo A. Lower lip reconstruction with nasolabial flap--going back to basics. An Bras Dermatol 2016; 90:206-8. [PMID: 26312718 PMCID: PMC4540552 DOI: 10.1590/abd1806-4841.20153714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 07/07/2014] [Indexed: 11/22/2022] Open
Abstract
Squamous cell carcinoma of the lower lip is frequent, and radical excision sometimes
leads to complex defects. Many lip repair techniques are aggressive requiring general
anesthesia and a prolonged post-operative period. The nasolabial flap, while a common
flap for the repair of other facial defects, is an under-recognized option for the
reconstruction of the lower lip. We describe the use of nasolabial flap for the
repair of a large defect of the lower lip in a ninety year-old male, with good
functional results and acceptable cosmetic outcome. We believe the nasolabial flap is
a good alternative for intermediate-to-large lower lip defects in patients with
impaired general condition.
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39
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Misra S, Haas CA, August M, Eberlin KR. Delayed Carotid Dissection Following Lower Lip Revascularization in the Setting of Hyoid Fracture--A Case Report and Review of the Literature. J Oral Maxillofac Surg 2015; 74:123-8. [PMID: 26435401 DOI: 10.1016/j.joms.2015.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 09/15/2015] [Indexed: 12/27/2022]
Abstract
Traumatic injuries to the lip are common, but injuries that require revascularization of the lower lip are infrequent and pose a major challenge to the reconstructive surgeon. This report describes the case of a 53-year-old woman who sustained a lower lip avulsion injury, a comminuted mandibular parasymphyseal fracture, and a hyoid bone fracture secondary to a bicycle accident. Trauma workup included computed tomographic angiography of the head and neck, which did not show vascular injury. Despite successful revascularization of the lower lip, on postoperative day 11 the patient developed a large internal carotid artery dissection and middle cerebral artery stroke. This case highlights the importance of careful postoperative monitoring after high-energy facial trauma, particularly in the setting of vascular and bony injuries.
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Affiliation(s)
- Shantum Misra
- Medical Student, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Corbett A Haas
- Resident Physician, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Meredith August
- Associate Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA
| | - Kyle R Eberlin
- Assistant Professor, Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
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40
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Denadai R, Raposo-Amaral CE, Buzzo CL, Raposo-Amaral CA. Functional lower lip reconstruction with the modified Bernard-Webster flap. J Plast Reconstr Aesthet Surg 2015; 68:1522-8. [PMID: 26243196 DOI: 10.1016/j.bjps.2015.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/06/2015] [Accepted: 07/12/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Lower lip defects after squamous cell carcinoma (SCC) excisions have been repaired by several surgical techniques. However, the functional reconstruction of full-thickness defects of the lower lip remains a therapeutic challenge. We therefore evaluated functional results of the modified Bernard-Webster flap for the reconstruction of full-thickness lower lip defects after SCC excisions. METHODS A prospective study was performed on all patients with lower lip full-thickness defects after SCC excisions greater than 1/3 of the lip, reconstructed with the modified Bernard-Webster flap in 2011-2013. Functional (sphincter, motor, and sensory functions) postoperative results were evaluated according to criteria previously adopted. RESULTS Twelve lower lip defects were reconstructed without complications, except for two (16.7%) wound dehiscence successfully managed. Ten (83.3%) patients presented transient and permanent functional abnormalities in the recent and late postoperative assessments. Ten (83.3%) patients classified the late functional results as satisfactory. CONCLUSIONS The modified Bernard-Webster flap proved to be an excellent alternative to repair full-thickness lower lip defects with more than 1/3 of the lower lip length, as it allowed the use of similar neighboring tissues, could be performed in one stage, and was functionally effective.
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Affiliation(s)
- Rafael Denadai
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
| | | | - Celso Luiz Buzzo
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
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Abstract
Reconstruction of the lip may be required after trauma and/or surgical excision of tumor. The lips contribute to form the beginning of the oral cavity, and they are the most common site of oral cancer. Any reconstruction of the lips must include both functional and cosmetic considerations. This case report presents a female patient, aged 22 years old, who was exposed to severe road traffic accident resulting in lower lip loss with both functional and cosmetic disturbances. Surgical reconstruction using Karapandzic flap was carried out at the Maxillofacial Surgery Department at Ramadi Teaching Hospital, Anbar Province, Iraq. A dynamic reconstruction with remaining lip tissue can provide superior results in terms of lip appearance and function.
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42
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Coskunfirat OK, Bektas G, Cinpolat A, Unal K, Coskunfirat N. Experiences with functional gracilis muscle flap in lower lip reconstruction. Microsurgery 2015; 37:487-493. [DOI: 10.1002/micr.22431] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 05/10/2015] [Accepted: 05/12/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Osman Koray Coskunfirat
- Department of Plastic, Reconstructive and Aesthetic Surgery; Akdeniz University School of Medicine; Antalya Turkey
| | - Gamze Bektas
- Department of Plastic, Reconstructive and Aesthetic Surgery; Akdeniz University School of Medicine; Antalya Turkey
| | - Ani Cinpolat
- Department of Plastic, Reconstructive and Aesthetic Surgery; Akdeniz University School of Medicine; Antalya Turkey
| | - Kerim Unal
- Department of Plastic, Reconstructive and Aesthetic Surgery; Akdeniz University School of Medicine; Antalya Turkey
| | - Nesil Coskunfirat
- Department of Anesthesiology; Akdeniz University School of Medicine; Antalya Turkey
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Wollina U. Reconstructive surgery in advanced perioral non-melanoma skin cancer. Results in elderly patients. J Dermatol Case Rep 2014; 8:103-7. [PMID: 25621090 DOI: 10.3315/jdcr.2014.1184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 07/12/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND Nonmelanoma skin cancer (NMSC) of the perioral region is not uncommon. Basal cell carcinoma is predominant in the upper lip area and squamous cell carcinoma in the lower lip area. While smaller lesions can be treated by excision followed by primary closure larger defects after tumor surgery can be challenging. OBJECTIVES Analysis of outcome after complete surgical excision with micrographical control of excision margins (delayed Mohs surgery) of large NMSC's of the perioral region (lips and chin). PATIENTS AND METHODS This is a retrospective, single-center analysis of patients with defects after delayed Mohs surgery of ≥ 3 cm of the perioral region. The study included a total of 25 patients (4 women and 21 men) with a mean age of 83.7 years. Twenty patients were diagnosed with squamous cell carcinoma and five had basal cell carcinoma. The lower lip was affected in 19 patients, the upper lip in 4 patients and the chin in 2 patients. Tumor stage was either T1N0M0 or T2N0M0. The most common procedure for lower lip defect closure was staircase or modified staircase technique. Cheek advancement flaps were used for upper lip defect closure. Inferiorly based nasolabial rotational flap, cheek rotational flap and modified Webster flap were also employed. In one patient Webster flap and unilateral staircase technique were combined. RESULTS In all patients the tumor was removed completely with preservation of function and aesthetics. No local recurrence was observed after a median follow-up of 4.9 years. CONCLUSION Perioral reconstruction after removal of large NMSC is a complex issue. The age group of over 70 years, frequently with comorbidities, requires a robust surgical technique with short operation times and tailored approaches for defect closure.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, 01067 Dresden, Germany
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44
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Schüller M, Gosau M, Müller S, Gerken M, Rohrmeier C, Legal S, Schreml S, Ettl T. Long-term outcome and subjective quality of life after surgical treatment of lower lip cancer. Clin Oral Investig 2014; 19:1093-9. [DOI: 10.1007/s00784-014-1327-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 09/19/2014] [Indexed: 11/30/2022]
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45
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Nyame TT, Pathak A, Talbot SG. The abbe flap for upper lip reconstruction. EPLASTY 2014; 14:ic30. [PMID: 25328575 PMCID: PMC4153100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Theodore T. Nyame
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Abraham Pathak
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Simon G. Talbot
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Mass,Correspondence:
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46
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Dorsalis Pedis Free Flap: The Salvage Option following Failure of the Radial Forearm Flap in Total Lower Lip Reconstruction. Case Rep Med 2014; 2014:458286. [PMID: 24803937 PMCID: PMC3996919 DOI: 10.1155/2014/458286] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 02/23/2014] [Indexed: 11/25/2022] Open
Abstract
Reconstruction after resection of large tumors of the lower lip requires the use of free flaps in order to restore the shape and the function of the lip, with the free radial forearm flap being the most popular. In this study we describe our experience in using the dorsalis pedis free flap as a salvage option in reconstruction of total lower lip defect in a patient with an extended lower lip carcinoma after failure of the radial forearm free flap, that was initially used. The flap was integrated excellently and on the followup the patient was free of disease and fully satisfied with the aesthetic and functional result.
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47
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Eskiizmir G, Baker S, Cingi C. Nonmelanoma skin cancer of the head and neck: reconstruction. Facial Plast Surg Clin North Am 2013; 20:493-513. [PMID: 23084301 DOI: 10.1016/j.fsc.2012.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Reconstruction of facial defects formed after resection of skin cancers is a challenging procedure. Achieving the best functional and aesthetic outcome depends on accurate preoperative planning. Reconstructive surgeons should perform a detailed analysis of the facial defect based on location, size, and depth and choose the most appropriate technique according to their experiences and patient preferences and expectations. This article reviews the preoperative analysis of facial defects, and the major principles and techniques of facial reconstruction. Discussed are reconstruction of the nose, lip, cheek, forehead, and eyelid, presenting for each technique the goals of the reconstruction, types of flaps and grafts, and surgical technique.
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Affiliation(s)
- Görkem Eskiizmir
- Department of Otolaryngology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
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48
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Sood A, Paik A, Lee E. Lower lip reconstruction: karapandzic flap. EPLASTY 2013; 13:ic17. [PMID: 23409208 PMCID: PMC3558851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Aditya Sood
- Division of Plastic Surgery, University of Medicine and Dentistry of New Jersey, Newark
| | - Angie Paik
- Division of Plastic Surgery, University of Medicine and Dentistry of New Jersey, Newark
| | - Edward Lee
- Division of Plastic Surgery, University of Medicine and Dentistry of New Jersey, Newark,Correspondence:
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49
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Cook JL. The reconstruction of two large full-thickness wounds of the upper lip with different operative techniques: when possible, a local flap repair is preferable to reconstruction with free tissue transfer. Dermatol Surg 2012; 39:281-9. [PMID: 23153375 DOI: 10.1111/dsu.12033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Large full-thickness wounds of the upper lip are often referred to operating room-based surgeons for repair given the perceived difficulties in restoring upper lip form and function with simpler operative techniques. OBJECTIVE To illustrate the functional, aesthetic, and cost differences between two techniques used to repair full-thickness wounds of the upper lip. MATERIALS AND METHODS Two patients with difficult full-thickness wounds of the majority of the upper lip were reviewed. One patient underwent reconstruction with a composite free flap in an operating room, and one underwent repair using local tissue rearrangement using bilateral modified nasolabial flaps in an outpatient setting. RESULTS Both patients were adequately reconstructed, but the patient repaired using local tissue rearrangement had a better aesthetic outcome and superior preservation of oral competency. In addition, the costs of this patient's reconstructive care were less than 2.4% of the costs of the care of the patient repaired using a free flap. CONCLUSION When possible, large, full-thickness wounds of the upper lip should be repaired with local tissue rearrangement in an outpatient setting to offer patients potential improvements in functional and aesthetic outcomes while minimizing treatment costs.
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Affiliation(s)
- Jonathan L Cook
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina 27710, USA.
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