Cross-lip Flap Research Articles

Upper Lip Reconstruction With the Alar Crescent Flap: A New Approach

The alar crescent advancement flap technique has been widely used for repair of large central defects of the upper lip and base of the nose because of its 1-stage procedural simplicity and good results. Several more complicated and multiple staged procedures that respect either structure or function, often compromising one to achieve the other, have become popular and have recently taken its place. However, these procedures are more complex and in many cases require a staged approach. In this study, we present a series of 33 patients who underwent reconstruction of large upper lip defects utilizing alar crescent flaps between 1992 and 2002. A series of 20 patients underwent reconstruction of large upper lip defects using alar crescent flaps between 1992 and 2002. Malignant etiologies were responsible for the defect in all patients. Reconstruction was performed as a 1-staged procedure in 19 cases. In 1 patient with a total upper lip defect, bilateral alar crescent flaps were used in conjunction with a cross lip flap that was later divided in a second stage procedure. All patients tolerated the procedure well with no major complications. Minor complications not requiring surgical intervention occurred in 5 patients. During the 12- to 60-month follow-up, all patients were found to be satisfied with the functional result. However, 7 patients underwent minor surgical procedures for esthetic improvement. There was no recurrence of disease in the 20 patients who underwent resection of malignancy. In these 20 cases, we have shown the utility of the alar crescent flap for varying length partial and full-thickness reconstruction of upper lip defects. This simple and straightforward technique provided good functional and esthetic results. The disadvantage of this procedure is the loss of philtral anatomic detail. Its primary advantage is that it is a single-stage procedure with a relatively low morbidity and patient inconvenience. As a single-stage technique it satisfies concerns over cost containment over more complex and staged procedures while still providing a good functional and cosmetic result. Furthermore, for those same reasons, this procedure is a good first choice in the elderly.

A new flap design for reconstruction of full-thickness defects of the lower lip: The extended upper lip island (EULI) flap

The extended upper lip island (EULI) flap has two advantages. It provides a wide mucosal surface, like that of the facial artery musculomucosal flap and does not leave a pedicle across the mouth. Aesthetic results with the EULI flap are almost as good as those with the cross-lip flap. An 89-year-old woman presented with squamous cell carcinoma of the lower oral vestibule. Full-thickness lower lip resection and marginal mandibulectomy, including resection of the surrounding gingiva and mucosa, were performed. The defect was reconstructed with an EULI flap that included the facial artery and vein. There were no severe postoperative complications, but two mild complications did occur: mild congestion of the distal end of the skin paddle and mucosa for two days after surgery and partial paralysis of the orbicularis oris and levator anguli oris muscles. The EULI flap is useful for extended lower lip reconstruction.

Reconstruction des pertes de substance totales de lèvre inférieure par doubles lambeaux hétérolabiaux. À propos d'un cas clinique

Total lower lip reconstruction can be performed with double cross-lip flaps. This simple technique gives satisfactory results both functionally and cosmetically. One clinical case is reported and the different procedures of total lower lip reconstruction are discussed.

Surgical Treatment Following Huge Arteriovenous Malformation Extending From the Lower Lip to the Chin: Combination of Embolization, Total Resection, and a Double Cross Lip Flap

A huge arteriovenous malformation (AVM) extending from the lower lip to the chin was surgically resected and the area was reconstructed during the same surgery in three patients. To control hemorrhage during surgery, a radiologist performed embolization of major arteries in the lesion 2 or 3 days before the surgery. After total resection of the AVM, facial reconstruction was performed by using a double cross lip flap from the upper lip and a local skin flap from the lower jaw. As a result, bleeding was well controlled, the AVM was totally resected, and satisfactory functional and esthetic results were obtained.

Reconstruction of nose and lips with tubed cervical flap in electrical injury: a case report

Electrical burn injuries occur worldwide and constitute 5–10% of all occupational fatalities. An analysis of human factors contributing to electrocutions has shown that carelessness is a major contributor. The management of these acute wounds has progressed over time, with the emphasis changing from a conservative approach to wound closure, then to the more aggressive doctrine of improving the functional and aesthetic outcome of the patients [1]. Factors that determine the type and extent of electrical burn injuries include voltage and current flow [1,2]. The spectrum of anatomic sites involved from electrical trauma is quite varied. The head is not a usual contact or entry point in high-tension burns but if involved, lips, nose and commissures may be affected. Young children usually aged between 1 and 3 years are frequent victims of electric burns of the lips [3]. It is rarely seen in adults. Several options are available for reconstruction of lips according to the extent of injury. Subtotal lip reconstruction can be performed using local flaps such as cross-lip and fan flaps. Total lip reconstructive efforts usually are suboptimal in providing an adequate oral sphincter, an acceptable aesthetic result or both. For total upper, lower or extensive combined soft-tissue defects that include both lips, traditional methods of reconstruction include the use of regional flaps such as the deltopectoral flap [4,5]. A more recent application is the use of the folded forearm flap to replace both the skin and inner lining, simultaneously, in full-thickness cheek and lip defects [6].

The partial-thickness cross-lip flap for correction of postoncologic surgical defects

Purpose: Abbe and Estlander cross-lip flaps have been described and designed as a full-thickness flap to reconstruct a full-thickness excisional defect. Some Mohs surgical excisions and other serial excisions leave partial-thickness defects. This article reviews a series of partial-thickess cross-lip flaps, which included some orbicularis oris muscle in the vermilion region but otherwise was a subcutaneous flap. Patients and Methods: In the last 7 years, 110 patients with lip cancer had their postsurgical defects reconstructed 24 to 72 hours after the resection. In all cases, negative margins were established by histologic evaluation or Mohs micrographic surgery. Twenty of 29 patients had Abbe- and Estlander- (lip-switch) type flaps, which were composed of a musculomucosal pedicle of 1.25 to 1.50 cm and an attached skin/subcutaneous flap trimmed to fit the defect. The remainder had full-thickness lip-switch flaps. Results: There were no vascular complications in either group. Four patients had notching or trapdoor- type bulking, which were revised after 3 to 6 months. Conclusion: The partial-thickness cross-lip flap has the same viability as the full-thickness flap within 1 cm from the inferior border of the mandible. © 2001 American Association of Oral and Maxillofacial Surgeons

Lip Reconstruction of Comparatively Large Defect Including the Commissure Using Remaining Lip Tissue: A Modification of Reconstructed Method

We present two reconstructed cases after malignant skin tumor of comparatively large defects of lip including the commissure using remaining lip tissue alone. After resecting a tumor including wedge-shaped full-thickness lip tissue, a full thickness oblique incision is made at the site 5 mm distant from the contralateral commissure. The rhomboid-shaped lower lip flap is created, transposed to the defect, and sutured with the defect margin, including the upper lip, to reconstruct the commissure. The cross lip flap is created at the contralateral side of the lower lip, 5 mm from the commissure, and the defect is closed with the crosslip flap. Although our method is applicable only to selected cases, we believe that it is useful in terms of maintaining symmetry of the lip and function of the commissure in the reconstruction of comparatively large defects including the commissure.

A New Design of a Cross-Lip Vermilion Flap

A new technique is described for the treatment of major vermilion defects using a cross-lip vermilion flap as a multistaged procedure. There is minimal disfigurement of the lip. The reconstruction is achieved using tissue of similar quality, texture, and color. The advantages of this method over the currently available techniques are discussed.

Bipedicled Axial Cross-lip Flap for Correction of Major Vermilion Deficiency after Cleft Lip Repair

Vermilion irregularities are common secondary deformities after cleft lip repair. Particularly severe in bilateral clefts, vermilion deficiency attracts considerable attention and detracts from an otherwise excellent lip repair. Minor and moderate vermilion deficits can be corrected with upper lip advancement, rotation flaps, tongue flaps, or grafts. Major defects defy correction with local flaps, because of an absolute shortage of upper-lip tissue. A technique is described for correction of large absolute tissue deficits of the upper-lip vermillion using a bipedicled lower to upper cross-lip visor flap. A lower lip wet vermilion/mucosal flap is based bilaterally near the commissures on the coronary arteries and transferred to a releasing incision at the wet/dry vermilion border of the upper lip. The commissural pedicles are divided and inset at a second stage 10 days later to complete the transfer. The procedure provides ample bulk and lining for major upper-lip vermilion augmentation and tubercle reconstruction without disturbing the obicularis oris muscular oral sphincter. In addition it balances the lips and allows for feeding. The technique is illustrated in two patients with major upper-lip vermilion defects after repair of bilateral cleft lips.

Bipedicled Axial Cross-lip Flap for Correction of Major Vermilion Deficiency after Cleft Lip Repair

Bipedicled Axial Cross-lip Flap for Correction of Major Vermilion Deficiency after Cleft Lip Repair

上口唇に生じたＭｅｒｋｅｌ ｃｅｌｌ ｃａｒｃｉｎｏｍａの１例

A 33-year-old male with Merkel cell carcinoma was reported. The tumor presented at the upper lip. Tumor was a recurrent one. And lectromicroscopy revealed dense core granules and tumor cells were stained by NSE and Keratin. Tumor was excised with 5mm surgical margin. The defect of the upper lip was reconstructed with cross lip flap. Radiotherapy was performed postoperatively. Three years after the treatment, he has no evidence of recurrence or metastasis.

Double cross lip flaps for reconstruction of the lower lip.

Squamous cell carcinoma of the lower lip is a common tumor. Of the many methods available for reconstructing lower lip defects after radical excision, we found double cross lip flaps from each lateral side of the upper lip philtrum rotated into the defect of the lower lip to be an effective method, not only functionally but also cosmetically. The main reason why satisfactory results were obtained by this procedure is that the anatomical structure (skin-orbicularis oris muscle-mucosa, vermilion) of the upper lip is very similar to that of the lower lip. Our experience is with double cross lip operations in the management of lower lip cancers are described.

Ornithine-vasopressin gangrene and reconstruction of the upper lip: Case report

A bilateral cleft lip and palate case received ornithine-vasopressin intra-operatively in preparation for a vasoconstricted field of the various lip segments prior to the repair of the cleft lip. A cyanotic tinge appeared immediately. This eventually led to total necrosis of the upper lip. Various relevant blood tests were done and a mild thrombocytosis was found. Surgical reconstruction of the upper lip was performed by means of a forked cross-lip flap--the main blood supply coming from the columella--as well as by means of an inferiorly pedicled cheek flap from the para-nasal area.

Immediate Repair of Upper Lip Defect with a Cross-Lip Flap

Jamra, Fawzi Abu M.D.; Graham, William P. III, M.D.; Graham, William P. III M.D. Author Information

Modification of cross-lip flap.

Modification of cross-lip flap.

Horizontal cross-lip flap with pedicle at commissure: case report.

Horizontal cross-lip flap with pedicle at commissure: case report.

A mucosal cross-lip flap

A mucosal cross-lip flap