Perioral Defects Research Articles

A New Option to Preserve Esthetics in Perioral Defect Reconstruction With Normal Anatomical Structures: Bipedicled Preexpanded Forehead Flap With Random Skin Flap Extension.

Plastic surgeons charged with reconstructing extensive perioral defects face dual challenges of functional restoration and esthetic considerations. While forehead flaps are commonly used to reconstruct perioral defects, in cases involving partial upper lip defects where normal anatomical structures are preserved, traditional forehead flaps may compromise esthetics. This study aimed to address this issue by employing bipedicled preexpanded forehead flaps based on the frontal branches of the superficial temporal artery (hereafter, "STA-bfb-based preexpanded forehead flap") with random flap extensions to repair perioral defects. Between April 2004 and July 2020, 7 patients (5 males and 2 females; 6 had post-burn facial scars involving the entire lower lip and part of the upper lip, and 1 presented with noma sequelae) underwent perioral defect reconstruction using this approach. Tissue expanders were placed in the forehead donor area, and an STA-bfb-based preexpanded forehead flap with random flap extensions was used to repair the perioral defect. The flap pedicle was divided into 3 weeks. All flaps remained viable with no perfusion-related complications. At follow-up 12 to 96 months later, the color and texture of the flaps demonstrated excellent compatibility with the surrounding skin, suggesting that the use of an STA-bfb-based preexpanded forehead flap with random skin flap extensions is a reliable method for repairing perioral defects. The authors' results have implications for plastic surgeons seeking a solution for challenging perioral defect reconstructions, balancing the need for esthetic outcomes with functional restoration.

Periorbital and Perioral Defect Reconstruction Using the Split Pre-Expanded Medial Arm Flap Aided by Using Indocyanine Green Angiography.

The pre-expanded medial arm flap provides suitable skin for the resurfacing of a periorbital or perioral defect. However, the flap must be intraoperatively split to imitate the appearance of the oral or ophthalmic fissure, which can compromise flap perfusion. This study aimed to evaluate the safety and effectiveness of splitting pre-expanded medial arm flaps with the aid of indocyanine green angiography. All 8 patients underwent periorbital or perioral soft tissue reconstruction using a split pre-expanded medial arm flap. Flap splitting was aided by indocyanine green angiography. It was used during 2 stages of the procedure, tissue expander placement and flap transfer. The pedicle was divided 3 weeks later, and the flaps were used to resurface the defect. The distal portion of the flap was split into a fishmouth pattern in 5 patients and a window pattern in 3 patients. The donor sites were closed directly or by using a latissimus dorsi myocutaneous flap. There were no perioperative complications or flap necrosis. A pre-expanded split medial arm flap could be an option for the reconstruction of periorbital and perioral defects. With the assistance of indocyanine green angiography, vessel distribution and distal flap perfusion can be reliably evaluated, facilitating the safe splitting of the flap for the reconstruction of defects.

A simple and effective method for reconstruction of perioral defects: the transverse V–Y advancement flap

A simple and effective method for reconstruction of perioral defects: the transverse V–Y advancement flap

Reconstruction of Perioral Defects After Mohs Micrographic Surgery or Excision: A Systematic Review of the Literature.

Although many repair methods for postsurgical lip defects have been described, the literature lacks a comprehensive review of these methods. To perform a systematic review of lip defect repair methods after Mohs surgery or excisions. Terms related to perioral anatomy, Mohs surgery and excision, and reconstruction were used to search 8 databases. Articles were included if they reported postsurgical lip repair data for 4 or more patients, were in English, and were published from 2004 onward. Two reviewers screened all titles and abstracts, followed by the full texts of the remaining articles. Data were then extracted including author specialties, study design, demographic, tumor, and defect information, surgical procedures, outcomes, and complications. Forty-two studies were eligible, including a randomized trial, 25 case series, and 16 cohort studies. Most were written by dermatologic or plastic surgeons, and most studies were small, with an average subject number of 61. Very few studies used structured outcome measures. Many repair methods were described, the most common of which were linear closures and various flaps. Many repair methods for lip defects have been published, but overall, the quality of the available evidence is low.

Single stage variation of myomucosal lip switch flap for secondary reconstruction of perioral defects.

Single stage variation of myomucosal lip switch flap for secondary reconstruction of perioral defects.

LIP AND PERIORAL RECONSTRUCTION USING LOCAL AND LOCO-REGIONAL FLAPS

Background: Peri-oral and oral soft tissue defects can be caused by several conditions, as resection of malignant and benign tumors, congenital malformations, traumatic injury. They can cause alterations in function and appearance of the affected area. Primary closure is the most commonly used technique for small defects, whilst medium and large defects require reconstruction with local, regional or free flaps. Local flaps are a good choice for reconstruction of medium-size defects of the lip, because they provide the same type of tissue, they are situated in proximity to the resected area, and they can be performed also in patients with multiple co-morbidities.Aim: To evaluate the role of lip and perioral reconstruction in plastic surgery unit of General Surgery Department, Zagazig University Hospitals.Methods: This study was carried out in plastic surgery department, Zagazig University Hospitals, from August 2018 to January 2019. It included 18 patients with perioral defects undergoing surgical tumor ablation. These patients were operated upon and referred to our outpatient clinic for the follow-up visits.Results: Out of 18 cases included, Karapandzic flap was used in 6 cases while mucosal advancement, rhomboidal flap were used in 4 cases. Hypothesia in 27.8%. Sialorrhea was in 16.7%. Microstomia was in 33%, partially satisfied in 50% and satisfied 50% after 6 months of the study.Conclusion: Local flaps provide the most satisfactory results and should be considered as the first choice for reconstruction of perioral defects.Keywords: Perioral reconstruction, local flaps, perioral defects.

Reconstruction of perioral defects post-Mohs micrographic surgery: a dermatological surgeon's approach.

The perioral location has great functional, aesthetic and social importance. Over 100 procedures have been described for lip reconstruction, emphasizing the challenges that reconstructive surgeons face when dealing with such defects. To outline the surgical reconstruction techniques of perioral defects post-Mohs micrographic surgery (MMS). The design and surgical techniques of reconstruction of perioral defects post-MMS are described. The results of the surgical techniques described are illustrated. Herein, we describe the nuances of reconstructive techniques that we have found useful for repairing perioral defects post-MMS.

Tongue flaps.

The tongue flap is a robust, versatile flap that can be used for reconstruction of oral, pharyngeal, and perioral defects of congenital, traumatic, and ablative origin. The rich blood supply and ease of use make the tongue flap a reliable and predictable reconstructive technique for indicated defects.

Reconstruction of Extensive Lip and Perioral Defects After Tumor Excision

The purpose of this study was to assess the clinical features, treatments, and results of extensive lip and perioral defects after tumor excision. This is a retrospective study of patients with extensive lip and perioral defects who underwent surgical interventions during the 7-year period from April 2005 to April 2012. The reconstructive procedures of lip and perioral defects were mainly performed with regional flaps or free flaps. Eleven patients with extensive lip and perioral defects were identified, and immediate lip and perioral defects reconstruction was performed with the folded free radial forearm flap in 2 patients, the free radial forearm flap and the forehead island flap in 1 patient, the pectoralis major myocutaneous flap in 2 patients, the submental island flap and the nasolabial flap in 1 patient, the folded thinned anterolateral thigh flap in 4 patients, and double skin paddle anterolateral thigh flaps and adjacent flap in 1 patient. All patients had good oral competence, and the cosmetic results were acceptable. Reconstruction of extensive lip and perioral defects after tumor excision is a challenge for the plastic surgeon. It should take into account the patient's condition, local tissue characteristics, previous treatments, functional needs, cosmetic aspects, and so on. The surgeon might need to reconstruct the lip with regional flaps or free flaps.

Aesthetic and Functional Outcome Following Perioral Defect Reconstruction Using the Facial Artery Perforator Flap

The facial artery perforator (FAP) flap was developed to facilitate reconstruction of perioral defects. Several studies reported promising results on the feasibility of using a FAP flap for this purpose, however, objective long-term outcome data are lacking. This study presents the aesthetic and functional outcome after reconstruction of perioral defects using a FAP flap. Between May 2001 and March 2009, 13 patients underwent perioral reconstruction with the use of a FAP flap. A panel consisting of five independent plastic surgeons rated the postoperative photographs based on a standardized questionnaire containing 5-point Likert scale questions and yes-or-no questions. In addition, the patients were contacted in March 2011 to give answers to a similar questionnaire over the telephone. Panel as well as patient reported questionnaire results demonstrated satisfying functional and aesthetic outcome after perioral reconstruction with a FAP flap. There was a high level of agreement amongst panel members, as judged by a low inter-rater variability. Previous studies suggested that the FAP flap is a valuable addition to facial reconstructive surgery. The results of the present study indicate that both aesthetic and functional outcomes are satisfying following perioral defect reconstruction using a FAP flap.

Versatile Use of Submental Tissue for Reconstruction of Perioral Soft Tissue Defects

To obtain optimum aesthetic result, perioral soft tissue defects require reconstruction using similar tissue. The submental area has very similar characteristics to perioral soft tissue and consists of thin, pliable tissue with a perfect color match. Therefore, we have used submental tissues for reconstruction of perioral soft tissue defects and application of the techniques, and results are discussed in this article. Between February 2001 and April 2008, 14 perioral soft tissue reconstruction procedures using the submental tissues were performed. The defect was on the upper lip including nasal columella in 5 cases, mentum in 3 cases, and oral commissure including buccal cheek in 6 cases. The techniques that were used included composite graft in 3 cases, local advancement flap in 3 cases, pedicled flap in 5 cases, and free flap in 3 cases. Patients were followed up for 9 months to 5 years. During this period, no major complications were noted, and satisfactory aesthetic results were obtained. All transferred submental tissues survived. In all patients, donor defects were closed primarily except in cases of local advancement flap. The donor-site scar was inconspicuous and well hidden below the mandibular margin and did not restrict neck motion in all patients. In particular, hair restoration on the flap was excellent in male patients. We believe that the submental area can provide useful soft tissue for perioral soft tissue defects because it provides a good color and texture match with perioral skin and can be harvested with minimal donor-site morbidity.

Deep-Plane Angle Rotation Flap for Reconstruction of Perioral Lesions

A cervicofacial flap remains the principal method to close defects of the posterior cheek. Schrudde described a variant of this technique, termed the angle-rotation flap, which allowed primary closure of the donor site. This flap has been elevated in the deep plane for the more medial defects. We extend this technique for upper lip reconstruction. Two cases were reviewed that underwent upper lip reconstruction with the deep-plane Schrudde flap. Two cases are presented to describe the use of the deep-plane angle-rotation flap. The first patient sustained a burn to his upper lip and the second patient had a partially grafted defect following a Mohs excision. In patients with insignificant nasolabial folds, the deep-plane Schrudde flap is a good option to reconstruct perioral defects. The utilization of the deep plane improves the blood supply and allows improved contour for reconstruction of deeper defects.

Lip and Perioral Trauma

The management of perioral injuries is a complex topic that must take into consideration the unique anatomy, histology, and function of the lips to best restore form and function of the mouth after injury. Basic reconstructive principles include three-layered closure for full-thickness lip lacerations. Additionally, special care is needed to ensure an aesthetic repair of the cosmetically complex and important vermillion border, philtrum, and Cupid's bow. Infraorbital and mental nerve blocks provide lip anesthesia for laceration repair without distorting crucial aesthetic landmarks. Prophylactic antibiotics are usually indicated in perioral injuries due to wound contamination with saliva. Perioral burn management is controversial; however, most lip burns can first be managed conservatively. Splinting, plasties, and other reconstructive options are available after secondary healing of perioral burns. Hypertrophic scars are common in the perioral area after trauma. The mainstays of treatment for hypertrophic scars on the lips are silicone elastomer sheeting and intralesional steroid injections. For large perioral defects, a myriad of reconstructive options are available, ranging from primary closure, cross-lip flaps, and local tissue transfer, to free tissue transfers such as radial forearm free flaps, innervated gracilis free flaps, anterolateral thigh free flaps, and osteocutaneous free flaps.

Where to find facial artery perforators: A reference point

Reconstructive surgery of the midface using facial artery perforator (FAP) flaps is being used more frequently now as it has been reported to provide better aesthetic results and reduce a traditional two-stage procedure to a one-stage technique. However, the wide acceptance of this approach is limited by a poor understanding of the anatomy associated with this technique. This was investigated through a cadaveric study. The facial artery (FA) of 16 cadaveric half-faces were each identified, cannulated with coloured latex and then dissected to give an accurate and quantified description of FA perforating branches. A lateral-view picture of each specimen was taken and analysed using ImageJ 1.42q. Cadaveric dissections showed that each hemiface could be regarded as a single entity. The values of the means were as follows: FA length=116±22 mm, FA diameter=2.62±0.74 mm, number of FAPs=4±2, FAP length=14.12±3.46 mm and FAP diameter=0.94±0.29 mm. A reference point, A, where FAPs were consistently found to originate, was also identified. Therefore, the FAP flap is a viable and valuable addition to plastic reconstructive techniques. The localisation of point A with precise measurements can facilitate the design and use of such FAP flaps for the reconstruction of nasal, as well as perinasal and perioral defects.

Recontouring commissuroplasty after reconstruction of large defects after resections for head and neck cancer with commissure involvement using an anterolateral thigh flap

The aim of this study was to describe our technique for recontouring commissuroplasty after reconstruction of large, through-and-through perioral defects in patients with head and neck cancer with emphasis on functional and cosmetic outcome. This technique was used in 15 patients aged between 33 and 66 years. Recontouring required liposuction, arrow-headed advancement flap, and anchoring vector sutures. All patients had satisfactory functional and cosmetic results and healed without complication. Function was evaluated to find out whether the patient was free of drooling and able to accommodate more food postoperatively. Aesthetic evaluation was subjective, and the patients themselves decided using a visual analogue cosmesis scale. Our combined procedures provide a predictable way of creating a new oral commissure, improving postoperative drooling, and increasing the intraoral space after reconstruction.

The Facial Artery Perforator Flap for Reconstruction of Perioral Defects

The Facial Artery Perforator Flap for Reconstruction of Perioral Defects

An island flap based on the anterior branch of the superficial temporal artery for perioral defects

ABSTRACTDefects following excision of lesions in and around theoral commissure extending on either lip are not infrequent. A majority of them are malignant. Various local flaps have been described to correct these defects, but sometimes they may not be feasible. However, the advantage of single-stage reconstruction can still be achieved by using an island forehead flap based on the anterior branch of the superficial temporal artery. This is a versatile flap with a reliable blood supply. It is relatively less popular as it involves time-consuming dissection.Aims: We have modified the island forehead flap based on the anterior branch of the superficial temporal artery by designing the flap on the frontoparietal region based on the terminal course of the anterior branch of the superficial temporal artery. Materials and Methods: This flap was used in five cases of perioral defects involving both the upper and lower lips including the angle of the mouth. Conclusions: Small to moderate dimension full thickness perioral defects can thus be reconstructed effectively with this modified flap in a single stage. The functional and aesthetic results are gratifying with minimal donor site morbidity.

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.

An island flap based on the anterior branch of the superficial temporal artery for perioral defects

Defects following excision of lesions in and around the oral commissure extending on either lip are not infrequent. A majority of them are malignant. Various local flaps have been described to correct these defects, but sometimes they may not be feasible. However, the advantage of single-stage reconstruction can still be achieved by using an island forehead flap based on the anterior branch of the superficial temporal artery. This is a versatile flap with a reliable blood supply. It is relatively less popular as it involves time-consuming dissection. Aims: We have modified the island forehead flap based on the anterior branch of the superficial temporal artery by designing the flap on the frontoparietal region based on the terminal course of the anterior branch of the superficial temporal artery. Materials and Methods: This flap was used in five cases of perioral defects involving both the upper and lower lips including the angle of the mouth. Conclusions: Small to moderate dimension full thickness perioral defects can thus be reconstructed effectively with this modified flap in a single stage. The functional and aesthetic results are gratifying with minimal donor site morbidity.

The Facial Artery Perforator Flap for Reconstruction of Perioral Defects

The concept of the facial artery perforator flap was developed to gain more freedom for reconstruction of perioral defects. Single perforators of the facial artery should supply a large area of facial skin for a pedicled perforator flap. Five fresh cadavers yielding 10 facial arteries were dissected after Microfil vascular injection to study distribution, number, length, and diameter of facial artery perforators. Five clinical cases with cancer-related perioral defects were reconstructed with facial artery perforator flaps. In two cases, additional regional flaps were used. Surgical technique was governed by the aesthetic unit principle and Doppler identification of the facial artery, which was used as a guideline for identification of suitable facial artery perforators. Cadaver dissection showed a large number of evenly distributed facial artery perforators (average, 5.7; range, three to nine). The average perforator length was 25.2 mm (range, 13 to 51 mm). The average perforator diameter was 1.2 mm (range, 0.6 to 1.8 mm). In all clinical cases, a suitable facial artery perforator was identified to meet reconstructive demands. Flaps were rotated up to 180 degrees. Four flaps survived completely. One flap showed minor distal necrosis. The facial artery perforator flap offers a versatile tailor-made flap, because of the reliable presence of perforators, with a large arc of rotation and an aesthetically pleasing donor site. The thin pedicle makes it an ideal flap for one-stage reconstruction without secondary revisions.