Karapandzic Flap Research Articles

Karapandzic flap: A case-report

For full-thickness lip defects, the choice of reconstructive option depends on the size of the defect. Defects of one-quarter to one-third of the upper lip can be closed primarily. Larger defects measuring one-third to two-thirds of the lower lip width may be closed with the Karapandzic, Abbe or Estlander flaps. If the commissure is involved, both the Karapandzic and Estlander flaps may be used; however, the Karapandzic is probably the better choice because it is better at maintaining oral competence. In the case of larger lower lip defects (more than two-thirds of the lip), if there is sufficient adjacent cheek tissue, the surgeon may employ the Karapandzic (for defects up to three-fourths of the lower lip width) or the Bernard-Burow's techniques (to reconstruct the entire lower lip). A case of post-traumatic, lower lip defect, reconstructed with a bilateral karapandzic flap is presented here.

Lip Reconstruction Using Karapandzic Flap

Reconstruction of the lip may be required after trauma and/or surgical excision of tumor. The lips contribute to form the beginning of the oral cavity, and they are the most common site of oral cancer. Any reconstruction of the lips must include both functional and cosmetic considerations. This case report presents a female patient, aged 22 years old, who was exposed to severe road traffic accident resulting in lower lip loss with both functional and cosmetic disturbances. Surgical reconstruction using Karapandzic flap was carried out at the Maxillofacial Surgery Department at Ramadi Teaching Hospital, Anbar Province, Iraq. A dynamic reconstruction with remaining lip tissue can provide superior results in terms of lip appearance and function.

One stage reconstruction of large lower lip carcinoma, with local flaps

Squamous cell carcinoma (SCC) of the lower lip is a frequently diagnosed malignant pathology in the maxillofacial region. It is a slow-growing cancer, and can be diagnosed and treated easily and effectively; however, early treatment is important because its mortality rate is 10%-30%. Reconstruction for a large lower lip defect is surgically challenging, especially reconstruction with local flaps. Here, we present a 52-year-old male with a large T3 SCC, which started 13 years before this treatment and involved nearly all of his lower lip, oral commissure and upper lip. It was reconstructed by local flaps with good aesthetic and functional results. The lip was reconstructed with a combination of a Karapandzic flap on one side and a contralateral Webster cheek advancement, using a functional neck dissection on the tumor side and supraomohyoid neck dissection contralaterally. Histopathology results of the neck were negative for metastasis. We were satisfied with the aesthetic and functional results of the neck.

Reconstruction de la lèvre inferieure par lambeau de Karapandzic

Introduction : The main etiology of the defects of the face is the excision of skin tumors. Lip reconstruction or cheiloplasty can use several techniques. Karapandzic flap provides good coverage of these losses of substances with good aesthetic and functional results. Observation : A 67 years old patient presents a spinocellular carcinoma of the lower lip measuring 4.5 cm × 4 cm. Resection repects a margin of 1cm. A bilateral rotation flap wich incisions are parallel to the free edges of the lips and equal to the height of the defect was performed. A back cut on the mucosal side allows better advancement of the flaps. They are sutured to each other. The postoperative course is simple. The aesthetic and functional results are very satisfactory with a decline of 6 months. Discussion : This is an excellent technique because it bends to the principles that are functional, morphological and aesthetic. It respects vessels: coronary facial artery, sensory and motor branches of the myocutaneous flap to obtain a buccal sphincter effective immediately. The mouth opening is satisfactory due to the elasticity of the tissue flap. Secondary commissuroplasty is not systematic. Most often, the incision seat in the nasolabial fold and goes higher or lower depending on the size of the defect. The upper limit of the incision is a few millimeters below the nostril. Conclusion : The Karapandzic flap used to the lower lip reconstruction after tumor resection gave good functional, morphological and aesthetic results.

Prospective Comparative Study of Lower Lip Defects Reconstruction With Different Local Flaps

Squamous cell carcinoma is the most common malignancy related to the lips (95%), and the lower lip is more commonly involved. Loss of tissue in the lower lip is treated with a variety of techniques, depending on the extension and location of the defect. This was a prospective case series. In this study, 41 patients with squamous cell carcinoma (30 males, 11 females) who were referred to Razi Hospital of Tehran University of Medical Sciences between 2007 and 2008 and underwent lower-lip reconstruction were included. Defects were divided into 4 groups: less than 30%, between 30% and 50%, between 50% and 80%, and more than 80%. Five different local flaps were used for lower-lip reconstruction. Karapandzic flap was used for 9 patients, double reversed-Abbe flap for 6 patients, Abbe-Estlander and step-ladder flaps for 8 patients, and 10 patients underwent reconstruction operation with reversed-Abbe flap. In comparison to reversed-Abbe flap and step-ladder flap, there were no differences functionally and aesthetically except that the step-ladder flap was a single-stage procedure, but the reversed-Abbe flap had 2 stages. There were no functional problems in patients with Estlander flap, but these patients complained of lip asymmetry. There were no functional complaints and aesthetic problems in patients with double reversed-Abbe flap at 3 months after the operation. In patients with 30% to 50% defect of the lower lip, there was no functional and aesthetic difference between Abbe flap and step-ladder flap. Estlander flap is a good choice for reconstruction of lateral or commissural defects of the lower lip. In patients with 50% to 80% defect, it is better to use bilateral reversed-Abbe instead of the Karapandzic flap.

Karapandzic flap for reconstruction of lateral upper lip defects

Introduction: The Karapandzic flap is a well-established method of reconstruction of large lower lip defects. However, its use in the reconstruction of upper lip defects is scarcely documented. We report our experience on the subjective and objective outcome of reconstruction of lateral upper lip defects with this flap.

Extended Karapandzic Flaps for Near-Total and Total Lower Lip Defects

Karapandzic flaps consist of well-vascularized, sensate lip tissue but are generally restricted to reconstruction of defects comprising two-thirds of the lip or less to avoid microstomia. Reconstruction of larger defects usually involves advancement flaps that require significant cheek laxity or free tissue transfer. The authors describe a modification of the Karapandzic lower lip reconstruction technique in which the flaps are extended by recruiting tissue from the perioral cheek, allowing reconstruction of near-total and total lower lip defects, which would normally not be reconstructible using the standard technique. Neurovascular structures are carefully dissected and preserved to ensure innervation and perfusion. Eight patients underwent successful single-stage lower lip reconstruction with this technique. In three cases, bilateral extended Karapandzic flaps were used for total lower lip defects, and in five additional cases, unilateral extended Karapandzic flaps were combined with other local flaps for near-total defects. All patients achieved oral competence and normal or near-normal mouth opening. One patient developed a hematoma and one patient developed a fistula that healed with conservative treatment. There were no other complications. Extended Karapandzic flaps can be used to reconstruct near-total or total lower lip defects with innervated, well-vascularized tissues that recreate the oral sphincter and restore oral competence. By extending conventional Karapandzic flaps with perioral cheek tissue, adequate length is gained to avoid microstomia. In addition, the color match of the reconstructed lip is superior to reconstructions relying on tissue transfer from distant sites.

Reconstruction of large defect of lower lip and commissure using karapandzic flap: Case report

Xeroderma Pigmentosum (XP) is a photosensitive skin disease with a high risk for developing skin malignancy. We present an 18-years-old boy with XP and recurrent basal and squamous cell carcinoma of lower lip. Because of scars from earlier resections Karapandzic circumoral advancement-rotation flap was performed. The method is suitable for defects covering 1/3 to 4/5 of the lower lip with possible involvement of commisura. 70% of the lip was resected and reconstruction was made with bilateral flaps. This reconstruction resulted in good oral muscular and sensory function. The scars followed natural folds of the face and despite a slight microstomia gave an acceptable esthetic appearance. The Karapandzic flap is simple and safe method for reconstruction of large defects of lower lip.

O.243 Finding an algorithm for microvascular bony reconstruction

Lip cancer represents between 12–15% of all oral cavity cancers; 95% affect the lower lip. The main objectives in lip reconstruction after tumoral mass resection are functionality and esthetics. We present the case of an 81-year-old male with a past medical history of squamous cell carcinoma of the maxilla. The patient consults with the Maxillofacial Surgery Department due to a hypertrophic lesion in the left oral commissure. The defect is considered intermediate in size (between 50% and two-thirds). For reconstruction of the lip, a classical rotation flap (Estlander flap) is used together with a myomucosal flap, which is both innervated and expandable. According to medical literature, for intermediate defects of the lower lip advancement or rotation flaps should be used. One of these is the Abbe-Estlander flap, a rotation flap dependent of the superior or the inferior labial artery. The Karapandzic flap and Johansen's staircase flap are other recommended techniques.

The Use of Combined Bernard-Webster and Karapandzic Flaps for Subtotal Lower Lip Reconstruction

The Use of Combined Bernard-Webster and Karapandzic Flaps for Subtotal Lower Lip Reconstruction

The simple modification of the reverse Karapandzic flap for reconstructing the subtotal upper lip including the columellar defect: a case report

Reconstruction of the subtotal upper lip with a columellar defect is still a problem for reconstructive surgeons. Various techniques have been reported for this purpose. Each technique has its own drawbacks, and few can be performed in one stage. Although Karapandzic describes the standard procedure that functionally reconstructs large defects in the upper and lower lip, the Karapandzic flap is not sufficient for the columellar defects. It is a simple and safe technique; results are satisfactory, functional, and aesthetically well tolerated, sacrifice less tissue, and are effective for repairing defects. We report a 74-year-old male who presented with a large, fungating, pus-discharging ulcerative mass on his upper lip including the columella. Biopsy results confirmed squamous cell carcinoma. The tumor was excised and defects were reconstructed using a simple modification of the Karapandzic flap. This modification of the Karapandzic flap provides adequate tissue for the subtotal upper lip defect including the columellar defect.

Karapandzic Flap for Reconstruction of Lip Defects

Systematic evaluation of the Karapandzic flap in the reconstruction of lip defects after ablative surgery. Patients who had a Karapandzic flap to reconstruct lip defects were analyzed with reference to demographic details, histology and location of the tumor, and dimensions of resection. The functional aspects of the reconstruction were assessed in terms of the size of the oral stoma, preservation of oral competence, and facial expression, in addition to speech, diet and ease of cutlery, and denture usage. The esthetic outcome was assessed with a 4-point scale and in addition the symmetry of the commissure at rest and function, preservation of the philtrum, and lip projection also were assessed. The complications were noted. Seven patients underwent Karapandzic flap reconstruction (4 males, 3 females) with an age range of 43 to 98 years. Three tumors were located in the upper lip, 4 in the lower lip, and there were 5 squamous and 2 basal cell carcinomas. The lip defects ranged from 40% to 75% of the lip circumference. The oral stoma was of a reduced circumference in all cases but did not lead to any functional compromise in terms of oral competence, facial expression, speech, diet, denture and cutlery usage, and sensation. There were no wound complications in our series. The esthetic outcome was considered excellent/good in 85% of cases. The commissure was symmetrical in all except 1 patient, the philtrum was preserved in all cases of lower lip reconstruction, and the projection of the lip was reduced in edentulous patients. The Karapandzic flap is a reliable technique that offers consistently good functional and esthetic outcomes after reconstruction of lip defects.

Regional flaps in oral and maxillofacial surgery

The term flap originated in the 16th century from the Dutch word flappe meaning something that hung broad and loose fastened only by one side. The flaps can be broadly classified as local random pattern and local axial pattern flaps; both of these flaps can be further classified as sliding or lifting types. We hereby present three case reports who reported to the Department of Oral and Maxillofacial Surgery, Subharati Dental College, Meerut in which we used Karapandzic flap, Nasolabial flap and Tongue flaps to reconstruct the defects.

A modified Karapandzic flap with intraoral free radial flap preserves function in the reconstruction after the oncological resection of the oral commissure

A modified Karapandzic flap with intraoral free radial flap preserves function in the reconstruction after the oncological resection of the oral commissure

O.014 Suitability of Karapandic method in lip reconstruction

For full-thickness lip defects, the choice of reconstructive option depends on the size of the defect. Defects of one-quarter to one-third of the upper lip can be closed primarily. Larger defects measuring one-third to two-thirds of the lower lip width may be closed with the Karapandzic, Abbe or Estlander flaps. If the commissure is involved, both the Karapandzic and Estlander flaps may be used; however, the Karapandzic is probably the better choice because it is better at maintaining oral competence. In the case of larger lower lip defects (more than two-thirds of the lip), if there is sufficient adjacent cheek tissue, the surgeon may employ the Karapandzic (for defects up to three-fourths of the lower lip width) or the Bernard-Burow's techniques (to reconstruct the entire lower lip). A case of post-traumatic, lower lip defect, reconstructed with a bilateral karapandzic flap is presented here.

Reconstruction of Perioral Defects Following Resection for Oral Squamous Cell Carcinoma

The aim of this study was to review and describe techniques for the reconstruction of large, complex perioral defects after resection of oral squamous cell carcinoma with emphasis on cosmetic and functional outcome. A review of techniques and selected case presentations using different flap designs for the reconstruction of large perioral defects following resection of squamous cell carcinoma was performed. The Bernard and Karapandzic flaps were used for large lower lip defects. A Zisser flap technique was used to reconstruct a large commissure defect. All reconstructed patients had acceptable functional results and healed without complication. The large lower lip defects were easily closed with the Bernard and Karapandzic flaps. The commissure defect was reconstructed using the Zisser technique. While cosmesis was acceptable in all cases, the commissure was the most difficult region to reconstruct with a favorable appearance. There were no flap failures. The Karapandzic flap led to greater rounding of the commissure area and the composite resection resulted in a lack of lower lip support that was improved with prosthesis. Function was noted to be excellent in the Bernard and Karapandzic flaps, with the patients able to purse lips and blow up balloon-type devices. The Bernard, Karapandzic, and Zisser flaps provide a predictable method to reconstruct large perioral defects following resection for oral cancer. Subsequent fabrication of a prosthesis can aid in lip support for the resected area.

Reconstruction for extensive defects of the lip

Reconstruction for extensive defects of the lip requires restoration of both function and form. To maximally achieve this, one should first preferentially utilize remaining lip elements for reconstruction, even accepting a smaller but functional oral sphincter. One should next consider using adjacent cheek for lip, ultimately relying upon distant free tissue transfer when local tissue is insufficient. For defects ranging from one third to two thirds of the lip, cross-lip procedures, such as the Abbe flap, work well, and are often used in combination with local lip advancements to reduce the size of the transferred lip segment. Karapandzic flaps, providing innervated vascularized lip tissue, also work well for defects up to two thirds of the lip, but for larger defects, significant microstomia will result. In patients with sufficient cheek laxity, reconstruction of defects of up to two thirds and even greater can be accomplished without microstomia by cheek advancements, such as the Webster-Bernard procedure. One should utilize free tissue transfers, such as the radial forearm free flap, for near total lip defects or defects in which chin and other tissues are missing. Such repairs offer surprisingly good function despite the fact that at best they provide a static damn or a hanging immobile "curtain" for lower and upper lip defects, respectively. Alternatively, Karapandzic flaps can be used in selected patients for near total lip defects, the resultant microstomia improved by revisional lip balancing and tissue stretching. Using "extended" Karapandzic flaps that recruit adjacent cheek tissue along with remaining lip elements can also be used for some near total lip losses, providing a one-stage solution with some innervated tissue while minimizing microstomia. In practice, many of the techniques mentioned above are used in combination to achieve the best functional and esthetic results.

The Karapandzic Flap in Recurrent Melanoma of the Lip

The Karapandzic Flap in Recurrent Melanoma of the Lip

Ｋａｒａｐａｎｄｚｉｃ ｆｌａｐと菱形弁にて下唇口角部を即時再建した頬粘膜（下唇粘膜）癌の１例

Many procedures have been described for reconstruction of the lips. Surgeons must strive to reconstruct an esthetic and functional lower lip. In 1974, Karapandzic described a procedure for reconstruction of lip defects by local arterial flaps. We describe a patient with buccal mucosa (lower lip mucosa) carcinoma in whom immediate reconstruction was performed using both a Karapandzic flap and a rhomboid flap. The outcome was satisfactory. A Karapandzic flap was particularly useful in reconstruction of the angulus oris.

Reconstruction of large lip defects

Reconstruction of very large lip defects is almost always difficult, simply because of the nature of the defect. Compromises are therefore often necessary. The best reconstructions are usually achieved using remaining lip elements and by restoring the continuity of the orbicularis oris muscle so that lip incompetence is minimized. One useful approach is to use a combination of Karapandzic and Abbe flaps to maximize redistribution of the remaining lip. With careful technique, acceptable results can often be achieved. If this is not possible, distant tissue can be used, but lip incompetence and drooling may result.