Full-thickness Defects Of Lower Lip Research Articles

Solving the Dilemma of Reconstructing Full Thickness Lower Lip Defects: Our Experience with the Sandwiched Nasolabial Flaps

Solving the Dilemma of Reconstructing Full Thickness Lower Lip Defects: Our Experience with the Sandwiched Nasolabial Flaps

Reconstruction of Lower Lip Defect with Unilateral Karapandzic Flap

The choice of reconstructive option for full thickness lower lip defects depends on the size of the defect. Defects between one-quarter to one-third of the lip can be closed primarily. Defects measuring between one-third and two-thirds of the lip may be closed with the Karapandzic, Abbe or Estlander flaps. When the commissure is involved, both the Karapandzic and Estlander flaps can be used. In case of larger lip defects, if there is sufficient adjacent tissue, Karapandzic flap or the Bernard techniques can be used to reconstruct the entire lower lip. In this article, we present a case of post-traumatic, lower lip defect along with chin defect, and parasymphyseal fracture mandible was reconstructed with a Karapandzic flap along with fracture reduction and fixation.

Lip reconstruction using the Gillies fan flap

The Gillies Fan flap is a single-stage composite rotational-advancement flap for reconstruction of medium to large full thickness lower lip defects. It can be thought of as an extension of the Estlander flap. It is nourished by a narrow superiorly-based pedicle of the superior labial artery. Mobilized tissue includes adjacent lower lip tissue as well as tissue from the opposing lateral lip. The oral commissure is distorted with use of this technique, and sometimes requires a second stage for refinement using a commissureplasty, discussed elsewhere in this issue. This flap is unique when compared with other reconstructive modalities of the lip because it requires a full thickness incision through the lip, thereby resulting in division of neurovascular and muscular structures, and as such has largely been replaced by the Karapandzic flap, which maintains the radial neurovascular supply, better preserving functions of the lip. This is accomplished by making incisions through mucosa and skin only, rather than full thickness as described herein. The Gillies fan flap can also be utilized using the MacGregor modification depending on the scenario.

Wing flap reconstruction for large defects of the lower lip

Full-thickness lower lip defects most often occur due to tumour resection or injury. Because the lower lip is important for both eating and speaking, reconstruction of the region must restore the structure and function of the tissue. Here, we describe a new procedure to reconstruct the lower lip, using a 'wing flap': a mental V-Y rotational advancement flap that contains the mental nerve. This flap can preserve the sensory innervation of the lower lip, and it allows effective reconstruction of the muscle sling. We have employed this method twice and have obtained good aesthetic and functional outcomes. No special technique is required to reconstruct the lip using this flap, and it yields a satisfactory outcome. Thus, we recommend it as an effective method for reconstruction in wide lower lip defects.