Keystone design perforator island flap for reconstruction of vermillion defects: A case series and literature review

Abstract

Many repair techniques have been recommended to treat lower lip defects. Although effective in many instances, some techniques are accompanied by complications, such as flap necrosis, dysesthesia of the lip, lip flattening, shortening, and loss of the vermillion roll. This study aimed to report the use of keystone design perforator island flap (KDPIF) in small to medium defects to achieve an effective and functional reconstruction of vermillion defects after Mohs surgery for lip cancer. A retrospective review of consecutive patients who underwent lower lip reconstruction after Mohs cancer resection at the same institution from June 2022 to September 2023 was performed. Patient information, including medical history, flap size, operative time, complications, and postoperative recovery of the lip function, was comprehensively evaluated. Six patients underwent reconstruction using KDPIF. The mean (range) operation time was 22.5 (19-31) min. None of the 6 patients exhibited flap splitting necrosis or infection, 6 patients (100%) had good to excellent cosmetic results, and no functional impairment was noted in any of the patients. KDPIF is a reliable technique for the reconstruction of vermillion defects, preserving lip fullness and the vermillion roll.