Simplifying Lip Reconstruction: An Algorithmic Approach

Reconstruction of Broad Lower Lip Defects Using Karapandzic-Type Flaps

BACKGROUND

Reconstruction of lower lip defects is challenging because of the functional and aesthetic demands of the lower face. We review the functional and aesthetic outcomes of the Karapandzic-type flaps for reconstructing lower lip defects.

METHODS

A retrospective review of patients who underwent repair using Karapandzic-type flaps.

RESULTS

Fifty patients with lower lip defects ranging from 20% to 95% (mean 59.2% ± 20%) were included. Eighteen patients (36%) were repaired using a bilateral flap, and 32 (64%) were reconstructed using a unilateral flap design. All patients had preservation of oral competency and a satisfactory aesthetic result. No patient complained of microstomia. A complication rate of 8% was noted ( n = 4) with postoperative wound infection and small areas of dehiscence. There was no statistically significant difference in complication rates in patients older than 75 years, in patients with a history of head/neck radiation, or in defects greater than 70% of lower lip breadth.

CONCLUSION

Karapandzic-type flaps are versatile and reliable for the reconstruction of a broad range of lower lip defects. This one-stage procedure can produce superior functional and aesthetic results as compared with other local and distant flaps with minimal risk of functional microstomia.

Squamous cell carcinoma of lip: Clinical feature analysis and suggestion of reconstruction algorithm

Reconstruction of lips after squamous cell carcinoma (SCC) removal should restore functional and aesthetic roles; however, it remains a challenge. In this study we describe the clinical features of lip SCC and suggest a reconstruction algorithm. We retrospectively analyzed 34 patients with lip SCC who underwent reconstruction after Mohs micrographic surgery between January 2006 and March 2022. The mean age of the patients was 70.2 years. Seven tumors were on the upper lip and 27 tumors were on the lower lip. Twenty-five defects were located on the mucosal lip, eight defects involved both the mucosal and cutaneous lips, and one defect was confined to the cutaneous lip. Eighteen defects were smaller than 50% of the total lip size, and 16 were larger than 50%. Primary closure was mostly performed for defects smaller than 50% of the lip size (9/18 cases), and local flap, according to the location and size of the defects, was performed for larger defects. Thirteen patients experienced postoperative complications but improved within 1 year after surgery, except for one patient. We suggest a reconstruction algorithm with a 50% cut-off value. Defects smaller than 50% of the lip size could be reconstructed by primary closure. Even larger defects could be reconstructed by creation of a local flap from the remaining adjacent tissue with minimal postoperative complications.

Squamous cell carcinoma of lower lip: the results of wide V-shaped resection

Generally, if the size of a lip cancer defect exceeds 30% of the lower lip, a local flap or free flap is recommended. However, defects up to 50% of the lower lip in size have been reconstructed successfully by primary closure without a local flap or free flap. In one case, an 80-year-old male farmer who had smoked for more than 50 years presented with squamous cell carcinoma of the lower lip and underwent mass resection and supraomohyoid neck dissection. The defect accounted for almost 2/3 of the lower lip and was repaired by primary closure with V-shaped resection. Biopsy results confirmed pT2N0cM0 stage II disease with clear margins. In another case, a 68-year-old male also presented with squamous cell carcinoma of the lower lip and underwent mass resection. The defect accounted for about half the size of the lower lip but was repaired by primary closure with V-shaped resection. Both patients experienced no discomfort while eating or speaking and were satisfied with the cosmetic and functional outcomes with no evidence of recurrence. Thus, direct closure can be considered even in large lower lip cancers.

Posttraumatic Lip Replantation in a Pregnant Woman

Traumatic lip amputation is a devastating injury. No other tissue replicates its unique histology, often limiting the reconstructive outcome. Replantation is a technically challenging procedure, requiring extensive postoperative optimization, including systemic anticoagulation, leech therapy, significant blood loss, and antibiosis. Given the rarity of replantation in the context of pregnancy, there are no documented accounts of lip replantation in pregnant patients. We report a case of a 25-year-old pregnant woman who sustained an avulsion injury of the right upper lip from a dog bite. The patient presented with the amputated lip and emergent microvascular replantation was performed. Postoperative course consisted of management of controlled yet significant blood loss through leech therapy and close collaboration with obstetric colleagues. The patient was ultimately discharged with successful cosmetic and functional outcome and, importantly, with maintenance of a healthy pregnancy.

Functional and Aesthetic Lower Lip Reconstruction Using the Yotsuyanagy Flap

ABSTRACT

Lower lip defects are a major challenge from a reconstructive perspective. The lower lip is an anatomical region formed by different types of tissue, and it is essential to obtain adequate functional and aesthetic results. When local tissue is available to be a donor area, it becomes the best option to repair the defect. This article's purpose is to present our experience in reconstruction of partial or transfixing total defects of the lower lip with the musculocutaneous flap of the depressor anguli oris described by Yotsuyanagi.

Use of Biologic Agents for Lip and Cheek Reconstruction

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.

Use of Biologic Agents for Lip and Cheek Reconstruction

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.

Ear Reconstruction after Mohs Cancer Excision: Lessons Learned from 327 Consecutive Cases

BACKGROUND

The ear serves many functional and aesthetic purposes, and its complex structure presents a notable challenge for reconstruction. A paucity of objective data and analysis on reconstruction of acquired ear defects remains. The goal of this study was to evaluate all ear reconstructions and the lessons learned over the past decades in treating these complicated defects in a large clinical Mohs reconstruction practice.

METHODS

A retrospective analysis of consecutive patients who underwent ear reconstruction after Mohs cancer excision from 2004 to 2018 performed by the senior author (J.F.T) was conducted. Data regarding patient demographics, oncologic type, treatment, defect characteristics, reconstructive modalities, number of stages, and complications were collected and analyzed.

RESULTS

Three hundred twenty-seven patients underwent ear reconstruction. Defects most commonly involved the superior one-third of the helix and the antihelix. Approximately half of the patients' defects were reconstructed with full-thickness skin grafts, and approximately one-third of the patients' defects required flap reconstruction. There were 30 complications (9 percent), ranging from partial flap loss to cancer recurrence. There was no difference in complication rates in elderly patients compared with the younger cohort.

CONCLUSIONS

Optimizing results when reconstructing ear defects is challenging, and there are multiple preoperative variables to consider. Ear reconstruction is safe in an outpatient setting, and age should not preclude patients from undergoing reconstruction of ear defects. The lessons learned from the past decade of ear reconstructions are demonstrated, and an algorithmic approach to treating these defects allows for a safe and reproducible method for reconstructing acquired ear defects.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.