Lower lip reconstruction with nasolabial flap--going back to basics

Infolding of Nasolabial Flap: An Excellent Surgical Technique for Full-Thickness Defect of the Lip

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.

Reconstruction of acquired lip defects: Ten-year experience at a tertiary care center

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.

Outcome of Nasolabial Flap in the Reconstruction of Head and Neck Defects

Nasolabial flaps have been recognized as versatile flaps for a variety of defects in the face, nose, lip and the oral cavity and intraoral defects created after the excision of benign and malignant tumours. Nasolabial flaps have been utilized for covering small-to-medium size defects and usually require a second-stage procedure to divide the flap. To study the outcome of nasolabial flap in the reconstruction of head and neck defects. A prospective analysis of 25 cases was done. Of this, 24 cases were oral cancers, and one case was post-traumatic left ala loss. Oral cancers from stage I to IVa were treated with primary wide local excision, nasolabial flap reconstruction and neck dissection. Of this, 3 cases underwent bilateral nasolabial flap reconstruction. Flap release was done as a second-stage procedure after 3 weeks. Good cosmetic and functional results were obtained in almost all cases. Flap tip necrosis was noted in 2 cases, ectropion in 1 case, orocutaneous fistula in 1 case and disease recurrence in 2 cases. Pedicled nasolabial flap is a reliable flap for the reconstruction of small- and medium-sized defects in the oral cavity after excision of primary tumours and results in good overall cosmetic and functional outcome.