Bilateral Musculocutaneous Unequal-Z Procedure

Abstract

Although several techniques have been described for total lower-lip reconstruction, it is still a major reconstructive challenge, which often requires lengthy and risky microsurgical procedures. Here, we present a new local procedure, namely, bilateral musculocutaneous unequal-Z procedure for functional reconstruction of total lower-lip defects. In this technique, 2 musculocutaneous flaps including the depressor anguli oris and platysma muscles, respectively, are used in an unequal Z-plasty manner on each side of the defect. The lip defect is closed by the means of extra tissue relaxation provided with bilateral Z-plasty maneuver. The oral sphincter is reconstructed by suturing the depressor anguli oris muscles to each other at the midline. The mucosal coverage is provided with mucosal flaps obtained from the buccal areas bilaterally. Over 2 1/2 years, this new technique was used in 8 patients, aged between 47 and 83 years, with total lower-lip defects resulted from excision of squamous cell carcinomas. All patients healed uneventfully. At 6 months, physical and electromyography (EMG) examinations revealed an intact oral sphincter with a normal sensitivity. One patient died because of lung metastasis at 8 months after surgery. A mean follow-up of 2 years revealed a functionally and cosmetically acceptable lower-lip reconstruction in all surviving patients. As a nonmicrosurgical local procedure providing an esthetically acceptable, sensitive, and functional lower lip, this new technique seems to be a useful alternative to the microsurgical procedures in total lower-lip reconstruction.