Reconstruction of Large Defects of the Lower Lip After Mohs Surgery

Abstract

Lower lip reconstruction should restore oral competence, speech, and cosmesis. These goals are a challenge when reparing large lower lip defects. Karapandzic flap is a reliable technique with consistent functional and esthetic outcome. In large defects, it might result in disproportion between the upper and lower lips and blunting of the commissures. The Abbe flap is useful as a lip balancing procedure and avoids the rounding of the commissures. Five cases of lower lip skin cancer treated with Mohs surgery with defects up to 80% were reconstructed with a combination of Karapandzic and Abbe flaps. All cases were performed under local anesthesia. We observed no complications related to wound or flap survival. All patients preserved function. Esthetic outcome was considered very good to excellent in 4 cases and good in 1. Mild micrsotomy wad observed in 1 patient. We believe that the standard Karapandzic and Abbe flap compares favorably with the modified Abbe plus modified Karapandzic flap combination in defects up to 80% because it is performed straightforward and can be done under local anethesia. Similarly, when compared with Karapanzic plus Burrow-Bernard-Webster combination in defects up to 80%, we believe that the standard Karapandzic and Abbe flaps are better both in function and in esthetics. In defects larger than 80%, both flap combinations are better than standard Karapandzic and Abbe flaps because of the risk of microstomy.