Simplified method of rotating skin and mucous membrane flaps for complete reconstruction of the lower lip

Abstract

D EFECTS of the lower lip result from inflammatory or degenerative processes, as advanced carcinoma’, 2 and extensive ulcerations (noma) ; or traumatisms from burnss or other accidents.4g 5 That’ reconstruction of these defects has been a surgical problem for many years is evidenced by the fact that according to Pierce and O’Conno~,~ over sixty-five methods and modifications of repairing complete or partial defects of the lower lip have been described in the literature. According to Martin6 von Bruns,7 as early as 1859, had found thirty-two methods described by fifty-two authors. That there have been so many different methods for the correction of this defect is indicative of the inexpedience of any one method. This fact should decry, on the one hand, the advancement of a new technique which may be only as good as others previously advocated, and yet, on the other hand, should be a stimulant to the development of a technique which fulfills satisfactorily all surgical requirements. Cheiloplasty for carcinoma of the lower lip, one of the oldest operations known, has been practiced since the days of Celsus (born about A.D. 25).B He is generally considered the originator of a method, the principle of which is still adhered to today-V-shaped incision and modifications including horizontal incisions from the angles of the mouth and along the lower edge of the mandible forming two lateral flaps of the cheek. Sccording to Fornan,’ the Hindus utilized rotating flaps from the adjacent tissues to rebuild a defect of the lip; this later became known as the lndian method. Tagliacozzi is accredited with the first description of a technique using flaps from the arm (1597).9 Chopart,‘o in 1785, reported the use of advancing flaps from the neck and chin for this purpose. Most of the operations advocated today are modifications of procedures, the basic principles of which were recognized in the early nineteenth century. BernardI and Burow and Saemann,l* in 1853, devised an operation in which full-thickness triangles were removed from the upper lip and discarded. The lower lip was then built by loosenin g and pulling the sides of the cheeks to the midline over the mandible. This procedure was modified by Steward,‘” in 1910, and Martin6 in 1932. In 1877, Estlander14 proposed a procedure which is one of the recognized methods of lip reconstruction today. A V-shaped incision is made. A similar defect only one-half the size is outlined at the outer border of the corresponding upper lip and excised completely, excepting the tissue where the coronary artery of the lip is located. The upper triangle is then turned down into the lower lip and sutured. In 1936, Padgett15 modified this operation by bringing