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Gao Y, Wang J, Gao Z, Zhou J. Classification and surgical treatment methods for partial traumatic upper lip deformity. Oral Dis 2024; 30:1245-1251. [PMID: 36577655 DOI: 10.1111/odi.14484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/10/2022] [Accepted: 12/20/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Establish a classification method for partial traumatic upper lip deformity and verify the classified repair method is superior to the traditional non-classified method. SUBJECTS AND METHODS Lip deformities caused by partial tissue defects of less than one-third of total lip length were classified into three types and conducted corresponding surgery based on philtrum ridge and orbicularis oris muscle involvement as well as the extent of roll line discontinuity. In this review, 42 cases were non-classified historical controls before the classification was devised, and 67 cases were classified. Data were collected 12 months after surgery. The pre- and post-operative data of all patients were compared. RESULTS In classified patients, the scar width decreased significantly, from 3.1 ± 0.6 mm to 1.2 ± 0.2 mm; the height difference of the groove line was significantly reduced from 3.3 ± 0.9 mm to 0.9 ± 0.1 mm; the ratio of the vermilion area of the affected to healthy side decreased significantly from 1.37 ± 0.31 to 1.05 ± 0.17; the ratio of the lip peak height of the affected to healthy side in type III decreased significantly from 1.91 ± 0.32 to 1.07 ± 0.12; patient satisfaction rate was about 98.5 percent. CONCLUSIONS Clinical outcomes showed significant improvement of lip aesthetics with a high patient satisfaction rate in the classified group than the non-classified group.
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Affiliation(s)
- Ya Gao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhen Gao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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de Buys Roessingh A, Robert Y, Despars J, Zbinden-Trichet C, Herzog G, Broome M, El Ezzi O. Unilateral Cleft lip and Palate: Long-Term Results of the Malek Technique. Cleft Palate Craniofac J 2024; 61:219-230. [PMID: 36453758 PMCID: PMC10751977 DOI: 10.1177/10556656221139671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
To review at 18 years-old the results of surgery and follow-up of children born in our hospital with unilateral cleft lip and palate (uCLP). They were operated at the time by the same surgeon, following the same primary surgical procedure (Malek). Retrospective cohort study. Tertiary Children's Hospital. All children born with uCLP between 1996 and 2001 and operated in our hospital. Syndromic children were excluded. Results of the primary surgery, ear-nose-throat interventions, maxillo-facial surgery and final phonatory results. Seventy-nine files of children born with a cleft were reviewed: 34 were taken into consideration for uCLP: 15 right and 19 left. They were operated in two stages, following the inverse Malek procedure. Sixty per cent had a fistula. Eighty-eight percent had grommets. Ninety-seven percent had an alveolar graft at a median age of nine (5-10) and 22% underwent a Le Fort osteotomy. Seven percent were operated for a pharyngeal flap, 29% for a secondary lip surgery at a mean age of 12.8 and 29% for a late rhinoplasty at a mean age of 14.8 years. A median of 5.7 multidisciplinary consultations was realized with a median number of general anesthesia of 7.1 (4-13). This retrospective study shows that the Malek procedure for children born with uCLP is related to a high risk of fistula but good long-term phonatory results. Twenty percent of children were operated for a Le Fort procedure and one-third for a secondary lip procedure and rhinoplasty.
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Affiliation(s)
- Anthony de Buys Roessingh
- Department of Pediatric Surgery, University Hospital Center of the Canton of Vaud (CHUV), Lausanne, Switzerland
| | - Yohann Robert
- Multidisciplinary consultations of facial cleft, CHUV, Lausanne, Switzerland
| | - Josée Despars
- Department of Pediatric Surgery, University Hospital Center of the Canton of Vaud (CHUV), Lausanne, Switzerland
| | - Chantal Zbinden-Trichet
- Department of Pediatric Surgery, University Hospital Center of the Canton of Vaud (CHUV), Lausanne, Switzerland
| | - Georges Herzog
- Department of Pediatric Surgery, University Hospital Center of the Canton of Vaud (CHUV), Lausanne, Switzerland
| | - Martin Broome
- Department of Pediatric Surgery, University Hospital Center of the Canton of Vaud (CHUV), Lausanne, Switzerland
| | - Oumama El Ezzi
- Department of Pediatric Surgery, University Hospital Center of the Canton of Vaud (CHUV), Lausanne, Switzerland
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Deitermann AM, Lin SK, Nugent ST, Raj LK, Beer J, Perz A, Shin TM, Sobanko JF, Etzkorn JR, Miller CJ. Tunneled island pedicle flap reconstruction for upper lateral cutaneous lip defects. J Plast Reconstr Aesthet Surg 2023; 81:119-121. [PMID: 37141785 DOI: 10.1016/j.bjps.2023.04.059] [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: 10/28/2022] [Revised: 03/23/2023] [Accepted: 04/18/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Esthetic upper lateral cutaneous lip reconstruction preserves the apical triangle, nasolabial fold symmetry, and free margin position. The tunneled island pedicle flap (IPF) is a novel single-stage reconstruction to achieve these goals. OBJECTIVES Describe the technique and patient and surgeon-reported outcomes for the tunneled IPF reconstruction of upper lateral cutaneous lip defects. METHODS Retrospective chart review of consecutive tunneled IPF reconstruction following Mohs micrographic surgery (MMS) at a tertiary care center between 2014 and 2020. Patients rated their scars using the validated Patient Scar Assessment Scale (PSAS), and independent surgeons rated scars using the validated Observer Scar Assessment Scale (OSAS). Descriptive statistics were generated for patient demographics and tumor defect characteristics. RESULTS Twenty upper lateral cutaneous lip defects were repaired with the tunneled IPF. Surgeons rated scars with a composite OSAS score of 11.83 ± 4.29 (mean, SD) [scale of 5 (normal skin) to 50 (worst scar imaginable)] and an overall scar score of 2.81 ± 1.11 [scale of 1 (normal skin) to 10 (worst scar imaginable)]. Patients rated their scars with a composite PSAS score of 10 ± 5.39 [scale of 6 (best possible score) to 60 (worst)] and with an overall score of 2.2 ± 1.78 [scale of 1 (normal skin) and 10 (very different from normal skin)]. One flap was surgically revised for pincushioning, but none experienced necrosis, hematoma, or infection. CONCLUSIONS The tunneled IPF is a single-stage reconstruction for upper lateral cutaneous lip defects with favorable scar ratings by patients and observers.
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Affiliation(s)
- A M Deitermann
- University of Minnesota Medical School, Minneapolis, MN, United States
| | - S K Lin
- Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, United States
| | - S T Nugent
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - L K Raj
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - J Beer
- Department of Dermatology, Tulane University School of Medicine, New Orleans, LA, United States
| | - A Perz
- Department of Dermatology, Boston University School of Medicine, Boston, MA, United States
| | - T M Shin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - J F Sobanko
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - J R Etzkorn
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - C J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States.
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Buccal Myomucosal Flap for Reconstruction of Red Lip Defects Close to Mouth Angle. J Craniofac Surg 2023; 34:e175-e178. [PMID: 35984003 DOI: 10.1097/scs.0000000000008943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/09/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Owing to the special esthetic and functional role in the face, red lip reconstruction presents a challenge to plastic surgeons. Various reconstructive techniques can be employed to fix the red lip defects close to the mouth angle. The purpose of this study was to demonstrate that the buccal myomucosal flap could be an available option to repair red lip defects with preservation of its esthetics and function. METHODS A single-center, retrospective study of 7 patients with red lip defects who were treated with buccal myomucosal flap was conducted between June 2017 and March 2022. All patients were followed up for at least 6 months including questionnaires and photography. RESULTS Of these 7 patients, 2 were women, and 5 were men. The average age was 14.3 years (range, 1-32 y). All the buccal myomucosal flaps survived well. All the donor sites were closed directly without complications. The average follow-up time was 33.4 months (range, 6-57 mo). All patients were satisfied with the aesthetic and functional results. CONCLUSION The buccal myomucosal flap is versatile and reliable, with the advantages of rich vascularity, flexible design, and easy access. This study was presented to highlight that the flap could be a good candidate to treat red lip defects close to the mouth angle.
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Martinovic D, Lupi-Ferandin S, Tokic D, Usljebrka M, Rados A, Pojatina A, Kadic S, Puizina E, Mihovilovic A, Kumric M, Vilovic M, Leskur D, Bozic J. Objective Skin Quality Assessment after Reconstructive Procedures for Facial Skin Defects. J Clin Med 2022; 11:jcm11154471. [PMID: 35956089 PMCID: PMC9369767 DOI: 10.3390/jcm11154471] [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: 07/08/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022] Open
Abstract
Local random skin flaps and skin grafts are everyday surgical techniques used to reconstruct skin defects. Although their clinical advantages and disadvantages are well known, there are still uncertainties with respect to their long-term results. Hence, the aim of this study was to evaluate outcomes more than one-year post operatively using objective measurement devices. The study included 31 facial defects reconstructed with local random flap, 30 facial defects reconstructed with split-thickness skin grafts (STSGs) and 30 facial defects reconstructed with full-thickness skin grafts (FTSGs). Skin quality was objectively evaluated using MP6 noninvasive probes (Courage + Khazaka GmbH, Cologne, Germany), which measure melanin count, erythema, hydration, sebum, friction and transepidermal water loss. The results showed that there were no significant differences in melanin count, erythema, hydration, sebum level, friction value and transepidermal water loss (TEWL) between the site reconstructed with random local flaps and the same site on the healthy contralateral side of the face. However, both FTSGs and STSGs showed significantly higher levels in terms of TEWL and erythema, whereas the levels of hydration, sebum and friction were significantly lower compared to the healthy contralateral side. Moreover, STSGs resulted in a significant difference in melanin count. These findings imply that the complex pathophysiology of the wound-healing process possibly results in better skin-quality outcomes for random local flaps than skin autografts. Consequently, this suggests that random local flaps should be implemented whenever possible for the reconstruction of facial region defects.
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Affiliation(s)
- Dinko Martinovic
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia; (D.M.); (S.L.-F.); (M.U.); (A.R.); (A.P.); (S.K.); (E.P.); (A.M.)
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (M.K.); (M.V.)
| | - Slaven Lupi-Ferandin
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia; (D.M.); (S.L.-F.); (M.U.); (A.R.); (A.P.); (S.K.); (E.P.); (A.M.)
| | - Daria Tokic
- Department of Anesthesiology and Intensive Care, University Hospital of Split, 21000 Split, Croatia;
| | - Mislav Usljebrka
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia; (D.M.); (S.L.-F.); (M.U.); (A.R.); (A.P.); (S.K.); (E.P.); (A.M.)
| | - Andrija Rados
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia; (D.M.); (S.L.-F.); (M.U.); (A.R.); (A.P.); (S.K.); (E.P.); (A.M.)
| | - Ante Pojatina
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia; (D.M.); (S.L.-F.); (M.U.); (A.R.); (A.P.); (S.K.); (E.P.); (A.M.)
| | - Sanja Kadic
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia; (D.M.); (S.L.-F.); (M.U.); (A.R.); (A.P.); (S.K.); (E.P.); (A.M.)
| | - Ema Puizina
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia; (D.M.); (S.L.-F.); (M.U.); (A.R.); (A.P.); (S.K.); (E.P.); (A.M.)
| | - Ante Mihovilovic
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia; (D.M.); (S.L.-F.); (M.U.); (A.R.); (A.P.); (S.K.); (E.P.); (A.M.)
| | - Marko Kumric
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (M.K.); (M.V.)
| | - Marino Vilovic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (M.K.); (M.V.)
| | - Dario Leskur
- Department of Pharmacy, University of Split Schwool of Medicine, 21000 Split, Croatia;
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (M.K.); (M.V.)
- Correspondence: ; Tel.: +385-21-557-871; Fax: +385-21-557-905
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6
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Qiu Y, Gao W, Lin X. Repair of a Total Defect in the Upper Lateral and Medial Lip. Dermatol Surg 2022; 48:769-771. [PMID: 33899798 DOI: 10.1097/dss.0000000000003043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Yajing Qiu
- All authors are affiliated with the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
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7
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One-Stage Reconstruction of Large Upper Vermillion Defects With Satisfactory Cosmetic Outcomes: Using a Lower to Upper Bipedicle Axial Cross-Lip Vermillion Flap. Ann Plast Surg 2022; 88:631-634. [PMID: 35502945 DOI: 10.1097/sap.0000000000003218] [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
BACKGROUND Vermilion deformities after intralesional bleomycin A5 injections for hemangiomas of the upper lip have not been rare during the past 2 decades in China. In this article, we summarized our 10 years of experience using a lower to upper axial cross-lip musculomucosal flap with bipedicle lower labial coronary arteries for 1-stage reconstruction of large upper vermillion defects. Based on several years of experience, we also created some modified approaches to achieve satisfactory cosmetic outcomes. PATIENTS AND METHODS From July 2006 to July 2016, a total of 25 patients with moderate and severe vermilion defects of the upper lip were treated with this method at the Department of Plastic and Reconstructive Surgery in Shanghai Ninth People's Hospital. The cosmetic outcomes and complications were reviewed. RESULTS The overall mean follow-up time was 14.9 months. No patients had infection or hematoma. All the flaps survived, and all the patients were satisfied with the postoperative appearance. CONCLUSIONS Our experience has proven that a lower to upper axial cross-lip musculomucosal flap with bipedicle lower labial coronary arteries is a safe and effective approach for correcting large upper vermillion defects. It is a 1-stage operation for the overall length of upper vermillion reconstruction. This method could improve upper-lip aesthetics and achieve reconstructive goals while avoiding lower-lip deformities.
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8
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The “Frogger Flap”: A Novel Quadruple Rhomboid Flap for Complex Central Upper Lip Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4072. [PMID: 35169517 PMCID: PMC8830814 DOI: 10.1097/gox.0000000000004072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/16/2021] [Indexed: 11/26/2022]
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9
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Sarrami SM, Skochdopole AJ, Ferry AM, Buchanan EP, Hollier LH, Dempsey RF. Revisional Techniques for Secondary Cleft Lip Deformities. Semin Plast Surg 2021; 35:65-71. [PMID: 34121941 DOI: 10.1055/s-0041-1728673] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Secondary deformities of repaired cleft lips are an unfortunate complication despite the meticulous approach of modern primary procedures. Most of these surgeries take place in the patient's early life and must be strategically planned to provide optimal cosmesis with minimal interventions. Depending on the level of severity, treatment of the secondary deformities ranges from noninvasive or minimally invasive techniques to complete revision cheiloplasty. Many novel topical, injectable, and laser therapies have allotted physicians more technical flexibility in treating superficial distortions. Nonetheless, surgical techniques such as diamond excision and adjacent tissue transfer remain popular and useful reconstructive modalities. Deformities involving the orbicularis oris must be completely taken down to allow full access to the muscle. Complete revision cheiloplasty requires recreation of the cleft defect and reconstruction similar to the primary repair. Due to the myriad of presentations of these secondary deformities, familiarity with the various treatments available is imperative for any cleft surgeon.
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Affiliation(s)
- Shayan M Sarrami
- 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
| | - Anna J Skochdopole
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, 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
| | - Edward P Buchanan
- 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
| | - Larry H Hollier
- 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
| | - Robert F Dempsey
- 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
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10
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Island Flap for Upper-Lip Reconstruction: Analysis of Key Aspects and a Case Series. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2020.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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11
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Xiao YD, Zhang MZ, Zeng A. Facial microcystic adnexal carcinoma — treatment with a “jigsaw puzzle” advancement flap and immediate esthetic reconstruction: A case report. World J Clin Cases 2021; 9:607-613. [PMID: 33553398 PMCID: PMC7829729 DOI: 10.12998/wjcc.v9.i3.607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 11/30/2020] [Accepted: 12/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Microcystic adnexal carcinoma (MAC) is a rare malignant tumor of the skin that is commonly found on the face. It grows slowly and has a low mortality rate. However, for various reasons, including strong histological invasiveness, clinical inexperience and inadequate procedure design, immediate or permanent facial deformity may occur after surgical operations.
CASE SUMMARY This article describes a middle-aged female artist who was diagnosed with MAC on the left upper lip. She declined the recommended treatment plan, which included two-stage reconstruction, skin grafting, or surgery that could have resulted in obvious facial dysfunction or esthetic deformity. We accurately designed a personalized procedure involving a “jigsaw puzzle advancement flap” for the patient based on the lesion location and the estimated area of skin loss. The procedure was successful; both pathological R0 resection and immediate and long-term esthetic reconstruction effects were achieved.
CONCLUSION This study suggests that when treating facial MAC or other skin malignancies, a surgical team should have sufficient plastic surgery-related knowledge and skills. An optimal surgical plan for an individual is needed to achieve good facial esthetics and functional recovery and shorten the treatment course.
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Affiliation(s)
- Yi-Ding Xiao
- Department ofPlastic Surgery, Peking Union Medical College Hospital, Beijing 100730, China
| | - Ming-Zi Zhang
- Department ofPlastic Surgery, Peking Union Medical College Hospital, Beijing 100730, China
| | - Ang Zeng
- Department ofPlastic Surgery, Peking Union Medical College Hospital, Beijing 100730, China
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12
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Tomás-Velázquez A, Redondo P. Island Flap for Upper-Lip Reconstruction: Analysis of Key Aspects and a Case Series. ACTAS DERMO-SIFILIOGRAFICAS 2020; 112:171-175. [PMID: 32931753 DOI: 10.1016/j.ad.2020.04.011] [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: 02/04/2020] [Revised: 03/29/2020] [Accepted: 04/21/2020] [Indexed: 11/17/2022] Open
Abstract
Upper-lip reconstruction after Mohs micrographic surgery is challenging for dermatologic surgeons. We describe a series of 15 patients (7 men and 8 women; mean age, 65.6 years) with skin cancer on the upper lip treated with Mohs surgery: 10 were basal cell carcinomas, 2 were melanomas, and 3 were squamous cell carcinomas. The resulting defects measured between 3 and 7.6cm. We used island flaps to reconstruct the defects in all cases, hiding the incisions in the nasolabial fold, at the line where the skin meets the vermillion border of the lip, and in the relaxed skin tension lines. We explain key aspects of the surgeries and design of the reconstructions, with emphasis on the importance of occasionally sacrificing small areas of healthy skin. Cosmetic and functional outcomes were satisfactory in all patients, and there were no postsurgical complications.
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Affiliation(s)
- A Tomás-Velázquez
- Departamento de Dermatología, Clínica Universidad de Navarra, Pamplona y Madrid, España.
| | - P Redondo
- Departamento de Dermatología, Clínica Universidad de Navarra, Pamplona y Madrid, España
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13
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Cutaneous Xanthogranuloma of the Face – An Uncommon Clinical Diagnosis and Challenging Reconstruction. ACTA MEDICA BULGARICA 2020. [DOI: 10.2478/amb-2020-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Cutaneous xanthogranuloma is a rare benign tumor and both adults and children could be affected. Head and neck area of the human body is the most commonly affected one which often poses a serious reconstructive challenge for the plastic surgeon who is in charge of removing the lesion. We report on a clinical case of an adult female patient who presented with cutaneous xanthogranuloma of the upper lip, involving the subnasal area. Both diagnosis and surgical treatment were difficult, considering the clinical behavior and location of the tumor. An innovative surgical approach going out of the dogmas of plastic surgery was applied and an excellent result was achieved.
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14
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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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15
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Dufourmentel Flap as an Aesthetic and Anatomic Refinement Tool in Upper Lip Repair. J Craniofac Surg 2020; 30:2617. [PMID: 31569183 DOI: 10.1097/scs.0000000000005954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Reconstruction of the upper lip represents a unique challenge because of its anatomical, functional and aesthetic requirements. In all the scientific sources and practical manuals the algorithms for central and lateral upper lip defects revolve around using advancement flaps, lip-switch techniques, and skin grafts only. The author offers a new approach for upper lip repair by using the Dufourmentel flap which is a pivotal local flap. The advantages and some tips are discussed.
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16
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Mantsopoulos K, Iro H, Constantinidis J. Complex midfacial defects: Is the extended Abbé flap the ideal solution to a tough problem? Oral Oncol 2019; 100:104470. [PMID: 31685290 DOI: 10.1016/j.oraloncology.2019.104470] [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: 10/10/2019] [Revised: 10/14/2019] [Accepted: 10/25/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the role of the extended Abbé flap in the reconstruction of complex midfacial defects (upper lip, nasal base and medial cheek). We describe our personal experience with this method and present some interesting aspects from the relevant literature. MATERIALS AND METHODS Between 2003 and 2017 we retrospectively evaluated the records of all patients with defects of the upper lip and nasal base after the resection of malignant tumors or traumata and reconstruction by means of the extended Abbé flap. We looked for information on the origin of the defect, the functional result, the aesthetic outcome and postoperative complications. The functional result of the reconstruction of the oral commissure was assessed with regard to postoperative subjective speech integrity, preservation of competence of the oral sphincter and lip sensation. The aesthetic outcome was evaluated with regard to limitations in facial expression and scar formation. RESULTS The study included 8 patients. Follow-up in the oncological cases was 85 months (range: 20-150 months). No tumor recurrences were detected. All patients achieved normal oral competence and mouth opening. No cases of blunting or microstomia were detected. CONCLUSION Reconstruction of the upper lip and nasal base with the extended Abbé flap is associated with an outstanding functional outcome that is cosmetically very acceptable.
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Affiliation(s)
- Konstantinos Mantsopoulos
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Jannis Constantinidis
- 1st Department of Otorhinolaryngology, Head and Neck Surgery, Aristotle University of Thessaloniki, Greece
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[Secondary cheiloplasty in the treatment of cleft lip and palates]. ANN CHIR PLAST ESTH 2019; 64:413-431. [PMID: 31492440 DOI: 10.1016/j.anplas.2019.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 07/16/2019] [Indexed: 11/21/2022]
Abstract
In the course of treatment of cleft lip and palates, the quality of primary cheilo-rhinoplasty is essential to limit aesthetic and functional complications. This is why these primary reconstructions come under the domain of specialised centres with multidisciplinary teams. Unfortunately, residual imperfections often remain, especially in bilateral clefts, and secondary cheiloplasties represent for us a complex challenge. They aim at functional and aesthetic correction, and the choice of time is very random and depends largely on the psychological repercussions of the deformation in the child. It often occurs at the age of school entry and is combined with alveoloplasty. We then speak of alveolar transplantation with vestibulo and labio-plastie, the GPVP. Then we propose to combine all the resources of cosmetic surgery to improve the aesthetic and functional result of these children.
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Discussion: Elegance in Upper Lip Reconstruction. Plast Reconstr Surg 2019; 143:585-588. [PMID: 30688907 DOI: 10.1097/prs.0000000000005289] [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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