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Moon BM, Pae WS. Reconstruction of a large lower lip defect using a combination of Abbe and staircase flaps: a case report. Arch Craniofac Surg 2022; 22:324-328. [PMID: 34974688 PMCID: PMC8721431 DOI: 10.7181/acfs.2021.00493] [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: 10/05/2021] [Accepted: 12/18/2021] [Indexed: 11/20/2022] Open
Abstract
Lip defects often occur following wide excision as a surgical treatment for squamous cell carcinoma of the oral cavity. Defects larger than one-half of the lip cannot be closed primarily and require flap surgery. Reconstruction of the oral sphincter function can be achieved by means of a local flap using the like tissue, rather than with a free flap utilizing different tissues. A defect of the lower lip requires reconstruction using different techniques, depending on its size and location. Herein, we present the case of a patient exhibiting a lip defect spanning more than two-thirds of the lower lip, after a wide resection due to squamous cell carcinoma. The defect was reconstructed using an Abbe flap and a staircase flap. Revision was performed after 16 days. The patient’s oral competencies were fully restored 3 months postoperatively, and the esthetic results were ideal. Based on our experience, a combination of the Abbe and staircase flaps can produce excellent functional and esthetic outcomes in the reconstruction of a lower lip with a large defect. It can serve as a reliable reconstruction option for defects spanning more than two-thirds of the lower lip, not including the oral commissures.
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Affiliation(s)
- Bo Min Moon
- Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Woo Sik Pae
- Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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A glycoprotein B-neutralizing antibody structure at 2.8 Å uncovers a critical domain for herpesvirus fusion initiation. Nat Commun 2020; 11:4141. [PMID: 32811830 PMCID: PMC7435202 DOI: 10.1038/s41467-020-17911-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/21/2020] [Indexed: 11/24/2022] Open
Abstract
Members of the Herpesviridae, including the medically important alphaherpesvirus varicella-zoster virus (VZV), induce fusion of the virion envelope with cell membranes during entry, and between cells to form polykaryocytes in infected tissues. The conserved glycoproteins, gB, gH and gL, are the core functional proteins of the herpesvirus fusion complex. gB serves as the primary fusogen via its fusion loops, but functions for the remaining gB domains remain unexplained. As a pathway for biological discovery of domain function, our approach used structure-based analysis of the viral fusogen together with a neutralizing antibody. We report here a 2.8 Å cryogenic-electron microscopy structure of native gB recovered from VZV-infected cells, in complex with a human monoclonal antibody, 93k. This high-resolution structure guided targeted mutagenesis at the gB-93k interface, providing compelling evidence that a domain spatially distant from the gB fusion loops is critical for herpesvirus fusion, revealing a potential new target for antiviral therapies. Herpesvirus virions have an outer lipid membrane dotted with glycoproteins that enable fusion with cell membranes to initiate entry and establish infection. Here the authors elucidate the structural mechanism of a neutralizing antibody derived from a patient infected by the herpesvirus varicella-zoster virus and targeted to its fusogen, glycoprotein-B.
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Abstract
We present an alternative method instead of classical methods for lower face reconstruction in this study involving clinical experiences. We aimed to achieve more esthetic and functional results using visor flap. This flap has been used for the reconstruction of lower lip and submental region in two patients. Satisfactory functional and cosmetic outcomes were obtained in patients. Flaps and donor sides healed with no complications. The hair follicles on the flap continued to grow in new locations. The visor flap is a useful alternative method for lower face reconstruction. This technique offers perfect color and texture matching and hair growth.
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Total lower lip reconstruction by bilateral Fujimori technique-A case report. Int J Surg Case Rep 2019; 58:96-99. [PMID: 31035229 PMCID: PMC6488680 DOI: 10.1016/j.ijscr.2019.04.014] [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: 02/09/2019] [Revised: 04/02/2019] [Accepted: 04/08/2019] [Indexed: 11/21/2022] Open
Abstract
Squamous cell carcinomas are the most common type of lower lip cancer. In cases where the tumour involves less than on third of the lower lip, direct suture maintains the physical appearance of a normal mouth with few adverse effects. Squamous cell carcinomas involving more than half or even most of the lower lip are not common. We report a successful case of complete lower lip reconstruction after recurrent squamous cell carcinoma involving most of the lower lip by use of bilateral Fujimori technique. CASE We present a case of full-thickness squamous cell cancer located to the vermillion border initially, but progressing rapidly in two months during radiotherapy to a state in which most of the lower lip, including the angles of the mouth, were affected. DISCUSSION Surgical management ensuring a functional and aesthetic acceptable outcome is a challenge in patients with large tumours including all of the lower lip. Several methods for reconstruction of the entire lower lip are discussed. CONCLUSION Bilateral Fujimori one-stage flaps can be used in cases of squamous cell carcinomas involving most of the lower lip, including the commissures of the mouth. A limitation of the method is an eventual lack of local tissue when preparing the flap.
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Abstract
Free flaps based on static slings principles cannot provide esthetic and functional outcomes at a desired level in total or close to total lip loss. Therefore, dynamic methods have become a current issue in recent years and especially the idea of functional gracilis free muscle flap has been suggested. In this study, we present a case of a successful total lower lip repair with this flap.In a 78-year-old female patient who was diagnosed with squamous cell carcinoma involving the entire lower lip, bilateral modified radical neck dissection and full-thickness total resection with 1 cm surgical margin so as to include both commissures of the tumor were performed and then a free gracilis muscle flap was transferred from the same side. After microvascular anastomoses, the motor nerve of the flap was coapted to the marginal mandibular branch of the fascial nerve. The entire intra- and extraoral surfaces of the flap were covered with a partial-thickness skin graft which was taken from the right thigh. There was no any intra- or early postoperative complication. The skin graft and flap survived without any problem.In the controls of the patient who was followed-up for 8 postoperative months, it was observed that the gracilis muscle flap was well-adapted to its place, gained a very good tonus, its volume reduced over time and reached to ideal dimensions, and the overlying skin graft provided a good color and texture match with the surrounding tissues. The motor activity of the muscle was monitored with the Tinel's test. The speech and facial expressions of the patient were very clear. Despite the patient has an edentulous mandible and was not using prosthesis, her feeding with fluid and solid foods was free of problems, oral competence was highly sufficient, and there was no any drooling. Esthetic appearance was very good and intraoral vestibular depth was sufficient. The mouth opening was 3 cm. When comparing with upper orbicularis oculi muscle on the electroneuromyography (ENMG) ordered at the 8th month, a similar nerve conduction time (3.3 versus 3.8 ms) and contraction amplitude (0.5 versus 0.4 mV) values were obtained from the gracilis muscle. Follow-up of the patient is still continued with no tumor recurrence observed during this period.Being the real dynamic flap and its tonus of the functional gracillis free muscle flap in opposite to the static methods provides a significant superiority over the other options in terms of oral functions; moreover, the overlying skin graft presents a very good color and texture harmony aesthetically. This method is a candidate to be an exclusive surgical technique in the repair of total or close to total lip losses in the future.
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Plantar reconstruction using a step-ladder advancement flap. JPRAS Open 2017. [DOI: 10.1016/j.jpra.2017.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] 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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Stein's Double Cross-Lip Flaps Combined with Johanson's Step Technique for Subtotal Lower Lip Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e615. [PMID: 27014544 PMCID: PMC4778886 DOI: 10.1097/gox.0000000000000555] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 10/06/2015] [Indexed: 11/26/2022]
Abstract
UNLABELLED In a previous study, a single cross-lip flap (Abbe flap) combined with Johanson's step technique for repair of defects of more than 2/3 of the lower lip was superior, in terms of aesthetic and functional outcome, compared with Bernard Webster-related techniques (cheek advancement). Herewith, a double cross-lip flap (Stein procedure) is proposed for repair of subtotal lower lip defects. A systematic review of the Stein procedure is provided. METHODS Two patients underwent a paramedian double cross-lip flap, preserving the aesthetic subunit philtrum column combined with the Johanson's step technique. The aesthetic and functional outcomes and the surgical steps are demonstrated in the videos. An electromyographic study was performed 6 months and 4 years after surgery. A PubMed and a Google Scholar search were performed for the Stein procedure published in 1848. RESULTS Lip competence was achieved directly after sectioning of the cross-lip pedicles in both patients. Lips progressivity expanded in the first 6 months. No microstomia was observed. Electromyography showed successful reinnervation of the transplanted muscles at 6 months. Four years after surgery, the electromyographic findings were consolidated. Since 1975, 7 articles on the double cross-lip procedure have been published: 4 in English, 1 in French, and 2 in Japanese. None of those articles reported on any supplemental lower lip advancement or on any electromyographic study. CONCLUSIONS The rationale of using 2 cross-lip flaps and a lip-cheek advancement according to Johanson seems to achieve functionally and aesthetically superior results compared with other techniques described for subtotal lower lip reconstruction.
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Degala S, Shetty SK, Monalisha. The karapandzic flap in lower lip reconstruction. J Maxillofac Oral Surg 2015; 14:421-5. [PMID: 25848152 DOI: 10.1007/s12663-014-0655-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 06/23/2014] [Indexed: 11/30/2022] Open
Abstract
Human bite injuries are both deceptive and challenging in their presentation and management. They are particularly notorious due to the polymicrobial nature of human saliva inoculated in the wound and the risk they pose for transmission of infectious diseases. Early treatment, appropriate prophylaxis and surgical evaluation are the key to achieving desired treatment outcomes. Here we present a case report of human lip bite with significant tissue loss that required reconstruction. The reconstructive techniques are usually varied but the ultimate objectives of treatment are to achieve healing, function, and aesthetics. Through this article, we have tried to focus on the diagnostic features, reconstructive procedure as well as other recommended treatment options for human lip bites based on the current available evidence.
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Affiliation(s)
- Saikrishna Degala
- Department of OMFS, JSS Dental College and Hospital, JSS University, Mysore, Karnataka India
| | - Sujith Kumar Shetty
- Department of OMFS, JSS Dental College and Hospital, JSS University, Mysore, Karnataka India
| | - Monalisha
- Department of OMFS, JSS Dental College and Hospital, JSS University, Mysore, Karnataka India
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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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Wollina U. Reconstruction of medial lower lip defects after tumour surgery: modified staircase technique. J Cutan Aesthet Surg 2014; 6:214-6. [PMID: 24470719 PMCID: PMC3884887 DOI: 10.4103/0974-2077.123409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The most common cancer of the lower lip is squamous cell carcinoma (SCC). Micrographically controlled surgery (Mohs surgery) is the golden standard of therapy in localized SCC. Since the majority of lip cancer patients is >60 years of life, planning of surgery and reconstruction has to consider the age and co-morbidities. The staircase or step technique is a robust method to achieve a good functional reconstruction in a one-step procedure. We also describe a modified staircase technique when SCC is not infiltrating the orbicularis oris muscle.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
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Huguier V, Bertheuil N, Parry F, Robiolle C, Dagrégorio G. [Post-traumatic reconstruction of the lower lip after total or subtotal amputation using the Webster's modification of the Bernard cheiloplasty -- advantages, disadvantages and limitations: three cases]. ANN CHIR PLAST ESTH 2013; 58:166-74. [PMID: 23333301 DOI: 10.1016/j.anplas.2012.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 12/18/2012] [Indexed: 11/18/2022]
Abstract
Webster's modification of the Bernard cheiloplasty is a well-known technique, usually applied to the reconstruction of total or subtotal amputations of the lower lip following oncological resection. We present three cases of post-traumatic reconstructions with interesting results.
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Affiliation(s)
- V Huguier
- Service de chirurgie plastique, CHU de Poitiers, BP 577, 2, rue de la Milétrie, 86021 Poitiers cedex, France
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Abstract
Oral reconstruction, especially with lower lip defects greater than 80% of the lip, is still challenging for plastic surgeons. Webster technique is mostly used for lower lip defects greater than 80% of the lip; however, resulting scars in the chin area (Schuchardt flap, a half-circle scar) are relatively conspicuous in Asian populations because of the trapdoor deformity. On the other hand, Johanson staircase flap technique, which is used to reconstruct lower lip defects of up to two thirds of the lip, results in relatively inconspicuous scarring and prevents trapdoor deformity. Thus, instead of Schuchardt flaps, we designed staircase flaps with a Webster technique. Two patients with lower lip carcinoma were operated on using this new technique. Large triangles of the skin and subcutaneous fat were removed from the nasolabial folds, and small staircases were removed from the lower lip to allow medial movement of the cheek tissues. The cosmetic and functional results were improved from the original Webster technique.
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Wave technique for treatment of lower lip cancer. J Craniomaxillofac Surg 2012; 40:e386-91. [PMID: 22440315 DOI: 10.1016/j.jcms.2012.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Revised: 02/02/2012] [Accepted: 02/02/2012] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This article reports the authors' experience with treatment of lower lip cancer using the wave technique. PATIENTS AND METHODS Twenty-one patients (16 males, 5 females) were treated using the wave technique between September 2009 and October 2010. Patients undergoing the procedure had tumors that were classified as either T1N0M0 or T2N0M0. Lateral defects less than 2 cm in size are generally treated with unilateral flaps, and median defects are closed with bilateral symmetric flaps. If the defect is paramedian and greater than 2 cm in width, two asymmetric flaps are used. RESULTS No recurrence was observed during a 6- to 32 months follow-up (mean 19 months). All patients showed excellent esthetic results with no microstomia. CONCLUSIONS We modified the straight lines of the staircase technique into round lines of the wave technique, resulting in an esthetic improvement. The goal of the broken lines and round lines is to create less visible scars. The wave technique can be used to close defects of up to two-thirds of the lower lip.
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Burusapat C, Pitiseree A. Advanced squamous cell carcinoma involving both upper and lower lips and oral commissure with simultaneous reconstruction by local flap: a case report. J Med Case Rep 2012; 6:23. [PMID: 22257635 PMCID: PMC3287129 DOI: 10.1186/1752-1947-6-23] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 01/18/2012] [Indexed: 11/20/2022] Open
Abstract
Introduction Squamous cell carcinoma is one of the most common malignant tumors of the skin and oral mucosa. However, squamous cell carcinoma involving near total upper and lower lip and oral commissure is rarely seen in the English literature. Simultaneous reconstruction of the upper and lower lips has been inconclusive and presents a challenge to the surgeon. We report such a case and outline our simultaneous reconstruction with local flaps. To the best of our knowledge this has never been reported. Case presentation A 73-year-old Thai woman presented with a large rapidly growing squamous cell carcinoma involving the upper lip, lower lip, left oral commissure and left cheek. En bloc resection of upper lip, lower lip, left oral commissure and buccal region was performed. Left radical neck dissection and right modified neck dissection were performed. Reconstruction of the upper lip with a left nasolabial-cheek cervicofacial rotational-advancement flap and right cheek advancement with perialar crescent flap was performed. The lower lip was reconstructed with bilateral labiomental advancement flaps. Conclusions Squamous cell carcinoma can grow rapidly and spread along the orbicularis oris muscle and across the oral commissure to the opposite lip. In advanced cancer, multimodal treatment is necessary. No gold standard in the reconstruction of both upper and lower lips has been established. We report the case of an advanced squamous cell carcinoma involving both the upper lip, lower lip, left oral commissure and buccal area and simultaneous reconstruction with local flap coverage that, to the best of our knowledge, has never been reported.
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Affiliation(s)
- Chairat Burusapat
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand 10400.
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Isik D, Garca MF, Durucu C, Goktas U, Atik B. Reconstruction of lower lip with myomucosal advancement flap. Head Neck 2011; 34:1562-9. [DOI: 10.1002/hed.21957] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 07/14/2011] [Accepted: 09/06/2011] [Indexed: 11/06/2022] Open
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Salgarelli AC, Bellini P, Magnoni C, Anesi A, Collini M. Synergistic Use of Local Flaps for Total Lower Lip Reconstruction. Dermatol Surg 2011; 37:1666-70. [DOI: 10.1111/j.1524-4725.2011.02151.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Koenen W, Goerdt S, Faulhaber J. [Structures of lip reconstruction]. Hautarzt 2011; 62:368-74. [PMID: 21509610 DOI: 10.1007/s00105-010-2088-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although the incidence of tumors of the lips is low, they are the most common oral tumors and their therapy is often challenging for the surgeon. Depending on the extent of resected lip tissue, various surgical procedures are performed for reconstruction. They all follow the goal to combine complete tumor resection with maximal functional and aesthetic restoration. Surgical procedures are classified regarding the direction of tissue mobilization into one-, two- and three-dimensional techniques. Even though more than two hundred different techniques have been described, only a small number are used on a regular basis. To select the appropriate procedure for the individual patient the exact anatomic location and size of the defect have to be taken into consideration. Treatment algorithms may guide the surgeon to a suitable reconstructive procedure for each case. Complications may occur more often due to the size and the site of the procedure. Final functional and aesthetic results are usually satisfying.
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Affiliation(s)
- W Koenen
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany.
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Pirgousis P, Fernandes R. Reconstruction of Subtotal Defects of the Lower Lip: A Review of Current Techniques and a Proposed Modification. J Oral Maxillofac Surg 2011; 69:295-9. [DOI: 10.1016/j.joms.2010.05.079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 05/11/2010] [Accepted: 05/20/2010] [Indexed: 10/18/2022]
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Faulhaber J, Géraud C, Goerdt S, Koenen W. Functional and Aesthetic Reconstruction of Full-Thickness Defects of the Lower Lip After Tumor Resection: Analysis of 59 Cases and Discussion of a Surgical Approach. Dermatol Surg 2010; 36:859-67. [PMID: 20618371 DOI: 10.1111/j.1524-4725.2010.01561.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jörg Faulhaber
- Department of Dermatology, University Medical Center Mannheim, Ruprecht-Karls University Heidelberg, Mannheim, Germany
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25
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Stepladder V–Y advancement medial thigh flap for the reconstruction of vulvoperineal region. J Plast Reconstr Aesthet Surg 2009; 62:e196-9. [DOI: 10.1016/j.bjps.2009.01.090] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 01/16/2009] [Accepted: 01/31/2009] [Indexed: 11/22/2022]
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Sebastian G. [Operative appraoches at problem sites]. Hautarzt 2008; 58:672-8. [PMID: 17569020 DOI: 10.1007/s00105-007-1355-4] [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: 10/23/2022]
Abstract
The term "problem site" is based on a constellation of factors including the disease itself, the anatomic site, the resulting excision defect and choice of the most appropriate wound closure technique. Typical problem sites are the nose, eyelids, hands (fingers and nails) and the anogenital region, each of which is a functional-aesthetic entity. As dermatologic surgeons become even more experienced in plastic and reconstructive surgery, the term"problem sites" will be used less often.
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Affiliation(s)
- G Sebastian
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland.
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Abstract
Lower lip reconstruction is ideally achieved with innervated flaps that supply mucosa, functional muscle, and skin. These flaps should be capable of being used when vermilionectomy is necessary. The size and shape of the defect determine the optimal flap. This article illustrates the flaps used by the authors for particular reconstructive problems.
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Roldán JC, Teschke M, Fritzer E, Dunsche A, Härle F, Wiltfang J, Terheyden H. Reconstruction of the lower lip: rationale to preserve the aesthetic units of the face. Plast Reconstr Surg 2007; 120:1231-1239. [PMID: 17898595 DOI: 10.1097/01.prs.0000279147.73273.e9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The boundaries of the aesthetic units of the face are often crossed after lower lip cancer surgery. The aim of this study was to compare the aesthetic and functional outcome after use of different operative techniques based on the concept of the aesthetic units of the face. MATERIALS Sixty-three patients were evaluated after lower lip reconstruction. The aesthetic outcome was recorded by standard photography evaluating the disruption of the boundaries of the aesthetic units of the face, lip projection, and the resulting facial expression. The functional outcome consisted of the evaluation of mouth opening, pouting, and lips at rest for the evaluation of mouth continence. Three techniques were used: wedge excision, the Webster-Fries method, and the step technique. The step technique was combined with an Abbé or an Estlander flap in defects involving more than two-thirds of the lip. RESULTS In defects involving up to one-third of the lip, the aesthetic outcome was better for the step technique than for wedge excision (a statistical trend was observed, p = 0.088). In defects involving two-thirds of the lip, the aesthetic and functional outcome was better using the step technique than the Webster-Fries method (p = 0.002), because the boundaries of the aesthetic units are respected. In defects involving more than two-thirds of the lip, the result was better using the step technique combined with the Abbé flap. CONCLUSION The authors have shown that the step technique alone or combined with a flap of the opposite lip is a rational approach for preserving the aesthetic units of the face and its function.
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Affiliation(s)
- J Camilo Roldán
- Regensburg, Bonn, Karlsruhe, and Kiel, Germany From the Departments of Oral and Maxillofacial Surgery, University of Regensburg and University of Bonn, Department of Oral and Maxillofacial Surgery, Institute of Medical Informatics and Statistics, University Schleswig-Holstein, Campus Kiel, and Department of Oral and Maxillofacial Surgery, General Hospital Karlsruhe
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Ducic Y, Athre R, Cochran CS. The Split Orbicularis Myomucosal Flap for Lower Lip Reconstruction. ACTA ACUST UNITED AC 2005; 7:347-52. [PMID: 16172347 DOI: 10.1001/archfaci.7.5.347] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To describe the split orbicularis myomucosal flap and to review our center's experience with this technique for large defects of the lower lip. METHODS All patients presenting to the senior author (Y.D.) for lower lip reconstruction using this flap were reviewed in a retrospective fashion. RESULTS A total of 14 patients with a minimum follow-up of 6 months (mean, 3.4 years; range, 6 months to 5 years) underwent lower lip reconstruction using the split orbicularis myomucosal flap from May 1999 to May 2004. Twelve of the defects arose as a result of cancer resection (squamous cell carcinoma [n = 8], basal cell carcinoma [n = 3], and melanoma [n = 1]), and 2 arose secondary to trauma. The defect crossed the vermilion in two thirds of the cases, extending for a variable distance onto the cutaneous portion of the lower lip. The defect size varied from 50% to 80% of the transverse dimension of the lower lip (mean, 68%) and involved the commissure in 4 patients. There were no flap failures, facial nerve palsies or paralyses, oral incompetence, or need for scar revision in any of our study population. CONCLUSION The split orbicularis myomucosal flap is a reliable method of reconstructing significant defects of up to 80% of the lower lip with minimal risks of microstomia or functional impairment.
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Affiliation(s)
- Yadranko Ducic
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, USA.
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Salgarelli AC, Sartorelli F, Cangiano A, Collini M. Treatment of lower lip cancer: an experience of 48 cases. Int J Oral Maxillofac Surg 2005; 34:27-32. [PMID: 15617963 DOI: 10.1016/j.ijom.2004.01.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2004] [Indexed: 10/26/2022]
Abstract
The article reports results obtained in 48 cases of lower lip cancer. Tumor classified as T1 or T2, requiring a resection up to 60% of the lower lip, were treated with the stair-case technique. Nine patients were treated with the bilateral symmetrical stair-case technique since their lesions were located medially, while 23 were treated with the bilateral method using two asymmetrical flaps because their lesions were in paramedian position but larger than 2 cm. Ten patients required a unilateral flap. The cases classified as T3, in which the lesion required resection of more than 60% of the lip, were treated with the Bernard-Freeman-Fries technique.
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Affiliation(s)
- A C Salgarelli
- Division of Maxillo-Facial Surgery, Carlo Poma Hospital, Mantua, Italy.
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31
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Ozdemir R, Ortak T, Koçer U, Celebioğlu S, Sensöz O, Tiftikcioglu YO. Total lower lip reconstruction using sensate composite radial forearm flap. J Craniofac Surg 2003; 14:393-405. [PMID: 12826811 DOI: 10.1097/00001665-200305000-00020] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In modern plastic and reconstructive surgery, shape and function must be considered together. These are the most important goals of any operation. There are a lot of techniques that have been reported for total lower lip reconstruction. It is believed that the radial forearm flap is the most suitable technique for lower lip and chin reconstruction after tumor excision so as to achieve better shape and functional results. The sensate radial forearm-palmaris longus free flap was used for total lower lip reconstruction in 17 patients with lower lip carcinoma with a mean age of 51 years. Two of the patients were female, and 15 were male. All the patients had squamous cell carcinoma. The patients were followed up for 1 to 3 years. Complications of these operations were partial superficial flap loss in 1 patient, partial graft loss in the donor areas of two flaps, and infection in only 1 patient. Wound dehiscence, fistula formation, suture abscesses, or sialocele was not seen in any patient. In this study, the aim was to demonstrate that the sensate radial forearm flap could produce acceptable esthetic results, good sphincteric function, and sensation in the early period after surgery.
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Affiliation(s)
- Ragip Ozdemir
- Ankara Training and Research Hospital, Plastic and Reconstructive Surgery Clinic, Number 6/28. Asagiayranci, 06540 Ankara, Turkey.
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32
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Schmid MH, Meuli-Simmen C, Hafner J. Repair of cutaneous defects after skin cancer surgery. Recent Results Cancer Res 2002; 160:225-33. [PMID: 12079217 DOI: 10.1007/978-3-642-59410-6_26] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
The goal of this chapter is to present an overview of the main clinical applications of surgical repair in the various anatomical regions of the head. Special consideration will be given to the areas that require reconstruction and to possible problems and complications. Although the skin lesion often dictates the type of incision made, there are various options. The biggest advantage of flaps is the excellent aesthetic result; this is feasible because the skin is similar in color and texture to that being replaced, and moreover no contracture occurs. On the other hand, a flap requires additional incisions and tissue movement, which increases the risks of postoperative complications. The range of flaps that can be used is discussed in detail. Full-thickness skin grafts are an important and necessary tissue source for reconstructive surgery in the face. They must meet the functional and aesthetic challenge posed by the surgical defect and are usually chosen because of the lack of adjacent tissue. Whenever possible, the skin grafts should resemble the surrounding skin in texture, color and thickness.
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Affiliation(s)
- Monika Hess Schmid
- Department of Dermatology, University Hospital of Zurich, Zürich, Switzerland
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Stricker M, Simon E, Duroure F. [Full thickness defects of the lips. Reconstructive techniques and indications]. ANN CHIR PLAST ESTH 2002; 47:449-78. [PMID: 12449872 DOI: 10.1016/s0294-1260(02)00146-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The full-thickness tissue loss of the lip leads to the loss of lip continuity. The classic principle is to repair a lip with a lip, giving the best results. Although the size of tissue lost can force to use local flaps, these could be naso-labio-jugal, labio-mental or submental. Even though the microsurgical labial replantation is the technique of choice, unfortunately, most of the time it cannot be done as a result of the situation and the conservation of the avulsed fragment.
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Affiliation(s)
- M Stricker
- Service de chirurgie maxillo-faciale et plastique de la face, CHU Nancy, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France
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34
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Okada E, Maruyama Y, Hayashi A. Stepladder dorsal metacarpal flaps for dorsal finger and hand reconstruction. Ann Plast Surg 2002; 48:48-52. [PMID: 11773730 DOI: 10.1097/00000637-200201000-00007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The authors demonstrate successful cases of stepladder dorsal metacarpal V-Y advancement and rotation-advancement flaps for reconstructing defects on the dorsum of the finger and hand. One side of the flap is designed in a multilobed shape, and each lobed flap is designed on the dorsum of adjacent fingers. These flaps are supplied by dorsal metacarpal vessels. Consequently, this method has the elements of the stepped incision technique, in combination with the V-Y and rotation-advancement principle. All flaps survived completely. This technique may be a useful option for reconstruction of defects of the dorsum of the finger and hand.
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Affiliation(s)
- E Okada
- Department of Plastic and Reconstructive Surgery, Toho University School of Medicine, 6-11-1 Ohmorinishi, Ohta-ku, Tokyo 143, Japan
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35
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Salgarelli AC. In reply:. J Oral Maxillofac Surg 2001. [DOI: 10.1053/joms.2001.29210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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36
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Schubert J. Variations in lower lip reconstruction. J Oral Maxillofac Surg 2001; 59:1511. [PMID: 11732047 DOI: 10.1016/s0278-2391(01)70081-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ord RA. Discussion. J Oral Maxillofac Surg 2001; 59:403. [PMID: 11292965 DOI: 10.1053/joms.2001.21876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Robert A. Ord
- Professor, Division Head of Oral Maxillofacial Surgery, University of Maryland, Baltimore, Maryland; e-mail:
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Salgarelli AC, Persia M, Ciancio P, Pagani R. The staircase technique for treatment of cancer of the lower lip: a report of 36 cases. J Oral Maxillofac Surg 2001; 59:399-402; discussion 403. [PMID: 11289170 DOI: 10.1053/joms.2001.21875] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE This article reports the authors' experience with treatment of lower lip cancer using the staircase technique. PATIENTS AND METHODS Thirty-six patients with stage T1 or T2 cancers of the lower lip were treated. RESULTS No recurrences were observed during a 6- to 32-month follow-up. All patients showed excellent aesthetic results and no microstomia. CONCLUSIONS The staircase technique can be used to close defects of up to two thirds of the lower lip. Two bilateral symmetric flaps are used for median defects; 2 bilateral asymmetric flaps are used for paramedian defects greater than 20 mm; and only 1 contralateral flap is required for paramedian defects up to 20 mm.
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Affiliation(s)
- A C Salgarelli
- Division of Maxillofacial Surgery, Azienda Ospedaliera Carlo Poma, Mantova, Italy.
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39
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Karacalar A, Turan S, Ozcan M. Use of the step-advancement V-Y flap in the temporal region. Plast Reconstr Surg 1998; 102:1757-8. [PMID: 9774043 DOI: 10.1097/00006534-199810000-00073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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40
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Hayashi A, Maruyama Y. Stepladder V-Y advancement flap for repair of postero-plantar heel ulcers. BRITISH JOURNAL OF PLASTIC SURGERY 1997; 50:657-61. [PMID: 9613413 DOI: 10.1016/s0007-1226(97)90516-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Random fasciocutaneous flaps with bilateral adipofascial pedicles were elevated from the posterior heel and transferred distally to defects of the postero-plantar heel in 4 patients, using a stepped incision technique, in combination with the V-Y advancement principle. In all cases the flap was successfully transferred without any linear scar or scar contracture in the posterior heel. The absence of recurrence of ulcers during the postoperative follow-up between 1.5 and 4 years indicated the reliability and durability of the flaps. Application of this procedure permits rapid resurfacing and excellent recontouring of small to moderate-sized defects of the heel with minimal donor site morbidity.
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Affiliation(s)
- A Hayashi
- Department of Plastic and Reconstructive Surgery, Toho University Hospital, Tokyo, Japan
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41
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Kuttenberger JJ, Hardt N. Results of a modified staircase technique for reconstruction of the lower lip. J Craniomaxillofac Surg 1997; 25:239-44. [PMID: 9368857 DOI: 10.1016/s1010-5182(97)80059-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Our experience with a modified staircase technique for closure of lower lip defects is reported. The procedure is based on the original technique of Johanson et al. (1974). However, the integrity of the orbicularis oris muscle is respected when advancing lower lip flaps. Twenty patients with squamous cell carcinoma of the lower lip were treated using this modified reconstruction technique. The size of the defects ranged from 30-60% of lower lip width. No recurrences were observed during a 3-year to 5-year follow-up. All patients showed symmetrical lip movement, an adequate buccal sulcus and intact labial commissures. No symptomatic microstomia was seen and the aesthetic results were excellent. The surgical technique is explained in detail. Four types of flap are presented according to the size and location of lip defects. Lower lip defects up to 60% of the lip width can be closed easily, with good aesthetic results. The technique is also applicable to upper lip reconstruction.
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Affiliation(s)
- J J Kuttenberger
- Clinic for Oral and Maxillofacial Surgery, Kantonsspital Luzern, Switzerland
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42
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43
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Campus G, Standoli N, Alfano C. Reconstruction of the lower lip with a full thickness nasolabial island flap. SCANDINAVIAN JOURNAL OF PLASTIC AND RECONSTRUCTIVE SURGERY AND HAND SURGERY 1994; 28:285-8. [PMID: 7899839 DOI: 10.3109/02844319409022013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We have used a full thickness nasolabial island flap to reconstruct the lower lip after excision of its median or paramedian part for carcinoma in 12 patients. The flap is transposed through a subcutaneous tunnel over the modiolus without interrupting the muscle fibres of the commissura. All the patients were men who smoked, with a mean age of 64 years, and they have been followed up for a mean of 18 months (range 6-36). Functional and aesthetic results were good in all cases; there have been no recurrences or lymph node metastases, and the only postoperative complications were two cases of superficial necrosis of the distal part of the flap which healed spontaneously without scarring. We think that the full thickness nasolabial island flap is a satisfactory technique for reconstruction of the lower lip.
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Affiliation(s)
- G Campus
- Cattedra di Chirurgia Plastica Ricostruttiva, Università di Sissari, Italy
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44
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Facial Flaps for Repair of Facial Defects. Oral Maxillofac Surg Clin North Am 1993. [DOI: 10.1016/s1042-3699(20)30727-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Defects of up to one third of the lower lip can usually be closed primarily, using one of the excision shapes described above. Defects of 30% to 50% of the lower lip can be closed with a stair-step or lip-switch flap. In most circumstances, stair-step reconstruction attains good function more quickly than the lip switch flap and has a better aesthetic result. Defects of 50% to 75% of the lower lip can be closed with a fan flap or a Karapandzic flap; the Karapandzic flap generally provides a better functional result. Both of these flaps cause rounding of the corner of the mouth that compromise the aesthetic result.
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Affiliation(s)
- K H Calhoun
- Department of Otolaryngology, University of Texas Medical Branch, Galveston 77550
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46
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Blomqvist G, Hirsch JM, Alberius P. Association between development of lower lip cancer and tobacco habits. J Oral Maxillofac Surg 1991; 49:1044-7; discussion 1048-9. [PMID: 1653824 DOI: 10.1016/0278-2391(91)90134-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Tobacco use is considered to increase the risk of tumor induction. The purpose of this case-controlled investigation was to assess the association of tobacco habits and development of squamous cell carcinoma of the lower lip. Sixty-one patients treated for lower lip cancer, aged between 42 and 90 years, were studied. Age- and sex-matched healthy controls showed a similar exposure to tobacco in years and a comparable distribution of tobacco habits. Although the mean exposure factor (duration times exposure) was greater in the tumor group, no intimate correlation between lip cancer and tobacco was demonstrated. However, an increased, although small, occurrence of herpes labialis lesions was found in cancer patients. The hypothesis is presented that smokers experiencing recurrent herpes simplex virus 1 (HSV-1) infections are more liable to tumor initiation, which issue will be subjected to a future study.
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Affiliation(s)
- G Blomqvist
- Department of Plastic Surgery, Sahlgrenska Hospital, University of Göteborg, Sweden
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47
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Evans DM, Martin DL. Step-advancement island flap for fingertip reconstruction. BRITISH JOURNAL OF PLASTIC SURGERY 1988; 41:105-11. [PMID: 3349214 DOI: 10.1016/0007-1226(88)90035-5] [Citation(s) in RCA: 90] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
An island flap is described for fingertip reconstruction, based on one neurovascular bundle. The design incorporates the stepladder principle, which ensures the provision of ample skin with full tactile sensibility in the required position, without the risk of longitudinal volar scarring and with good nail support when necessary. Fourteen such repairs have been carried out with satisfactory results and no complications.
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Affiliation(s)
- D M Evans
- Department of Plastic Surgery, Wexham Park Hospital, Slough, Berkshire
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48
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Blomgren I, Blomqvist G, Lauritzen C, Lilja J, Peterson LE, Holmström H. The step technique for the reconstruction of lower lip defects after cancer resection. A follow-up study of 165 cases. SCANDINAVIAN JOURNAL OF PLASTIC AND RECONSTRUCTIVE SURGERY AND HAND SURGERY 1988; 22:103-11. [PMID: 3387919 DOI: 10.3109/02844318809097942] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
One hundred and sixty-five patients with localized cancer of the lower lip were excised and reconstructed over a 25-year period using Bengt Johanson's step technique. Eight-eight percent of the tumors were less than 2 cm in size and 65% were of high histopathological differentiation. Fifty-six percent were reconstructed with bilateral step flaps. Nine local recurrences appeared in 5 patients, none of whom died of lip cancer. Eight patients later developed regional metastases and 3 of these patients died of lip cancer. The 5-year survival rate was 98%. The step technique is recommended for reconstruction of lip defects of up to 2/3 of the lower lip and may, in larger resections, be combined with either a fan flap or an Estlander flap. The outstanding functional results are due to the use of adjacent tissue for the reconstruction which preserves the normal arrangement of muscles, vessels and nerves.
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Affiliation(s)
- I Blomgren
- Department of Plastic Surgery, Sahlgrenska Hospital, Sweden
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49
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Abstract
The history of surgical reconstruction of the lips is outlined and a series of procedures described, which together enable lip reconstruction to be successfully undertaken in a variety of different circumstances.
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Affiliation(s)
- J D Langdon
- Department of Oral and Maxillofacial Surgery, King's College School, Medicine and Dentistry, London, Great Britain
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50
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Pitkänen J, Lahti A, Sundell B. Carcinoma of the lip. A retrospective study of 70 patients. SCANDINAVIAN JOURNAL OF PLASTIC AND RECONSTRUCTIVE SURGERY 1985; 19:289-94. [PMID: 4095514 DOI: 10.3109/02844318509074517] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
From 1966 to 1978, 70 patients with carcinoma of the lip were treated at the Division of Plastic Surgery, University Central Hospital, Helsinki. The lip tumour was a squamous cell carcinoma in 64 patients, and a basal cell carcinoma in 6 patients. Of these 70 patients, 24 had radiotherapy as the primary mode of therapy and 46 patients had been treated initially by surgery. The results of surgery were generally good. However, in the group of "simple wedge excision" and in patients who had had radiotherapy as the primary treatment there was a higher incidence of recurrences. In the former group the recurrences were considered to be due to a too narrow angle of excision. We recommend surgery as the primary method of treatment because of the availability of histologically accurate tumour margin assessment, the short rehabilitation period and the good functional results achieved.
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