Abstract
Upper lip defects caused by animal bites can result in serious oral and facial functional compromise. The management of such large defects in a way that an optimal functional and cosmetic outcome is reached remains a major reconstructive challenge. We present the upper lip reconstrucion of a 57-year-old woman who was attacked by her dog. The attack caused severe scalp and facial injuries, including a large upper lip defect. After initial trauma treatment, the lip defect was reconstructed by the combination of the Kazanjian and Abbe flaps. No venous circulation defect, wound healing problems or other complications were detected. After three months, sensory function of the area returned, and after 6 months the movements of the lip were satisfactory, the patient was able to pucker the lips, open the mouth and to eat. Beyond that, a cosmetically acceptable outcome was reached, so that the psychosocial reintegration of the patient was not at risk.We propose that combination of the Kazanjian and Abbe flaps offers an excellent alternative for the reconstruction of wide or total lip resections.
Highlights
Defects of the lips and the perioral area result mostly from malignancies, birth defects or trauma
Upper lip defects caused by dog bites can result in serious functional compromise in terms of oral competence, facial expression, speech, diet, denture- and cutlery use, and sensation
Several methods are known for the reconstruction of upper lip defects, such as the Abbé flap,the reversed Estlander flap, the Karapandzic flap, Kazanjian’s lower facial flap, and the Webster flap combined with Abbé flap
Summary
Defects of the lips and the perioral area result mostly from malignancies, birth defects or trauma. The patient suffered serious scalp and facial injuries involving the left side of the face, the nose, the eyes, the ears, and the upper lip (Figure 1). Several methods are known for the reconstruction of upper lip defects, such as the Abbé flap,the reversed Estlander flap, the Karapandzic flap, Kazanjian’s lower facial flap, and the Webster flap combined with Abbé flap. In cases involving large upper lip defects complicated by damages of the comissure, it is difficult to choose an appropriate method for reconstruction, and operative planning is not less challenging. The extent of the upper lip defect was over 70% and the left comissure was missing In this sense, it can be said that this case was surgically more challenging than larger injuries (like complete degloving) without significant tissue loss [12]. Sensory function of the area returned and after 6 months, the movements of the lip were intact, the patient was able to pucker the lips, open the mouth and to eat
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