Reconstruction Of Lip Defects Research Articles

The reliability and versatility of Facial Artery Perforator-Based Nasolabial Flaps in the Reconstruction of Lip Defects

The reliability and versatility of Facial Artery Perforator-Based Nasolabial Flaps in the Reconstruction of Lip Defects

Surgical Lip Cancer Reconstruction in the COVID-19 Era: Are Free Flaps or Loco-Regional Flaps Better?

Lip carcinoma is one of the most frequent conditions affecting the general population. It is among the ten most common neoplasms, but despite advances in research and therapy, its prognosis has not improved in a significant way in the past few years, making it a challenge in the medical research field and in surgical treatment. This study was conducted with the aim of evaluating the available reconstructive surgical options for the treatment of lip carcinomas in order to define which could be the most appropriate technique to achieve satisfying aesthetic and functional outcomes considering hospital resources in the COVID-19 era. Seventeen patients were included in this retrospective study, which took place between January 2019 and April 2021. There were two groups: seven patients who underwent a radial forearm free flap and ten who underwent locoregional flaps. The statistical analysis was performed to evaluate four different endpoints. Surgical length, ICU stay, and hospitalization time were minor for locoregional flaps. There was no statistically significant difference between the two groups when considering post-operative complications. Locoregional flaps have a more aesthetically pleasing result, but from a functional point of view, the results can be superimposable. Both techniques are associated with adequate speech, mouth opening, sealing, and symmetry. Given the impact of the COVID-19 pandemic on the healthcare system, locoregional flaps have been proven to be a good surgical option in the reconstruction of lip defects both in terms of aesthetics and functional outcome.

The Efficacy of Facial Artery Musculomucosal Flap in Reconstruction of Lip Defects

The Efficacy of Facial Artery Musculomucosal Flap in Reconstruction of Lip Defects

The Efficacy of facial artery musculomucosal flap in reconstruction of lip defects

The Efficacy of facial artery musculomucosal flap in reconstruction of lip defects

Transposition nasolabial flap: A versatile flap for sensate reconstruction of lip defects.

Lip reconstruction aims at maintaining the function and aesthetics of the facial subunits. Sensation in the reconstructed lip helps in bolus formation, tactile discrimination, and thermal sensation. In this study, we aim to describe random pattern nasolabial flap for lip reconstruction using various functional parameters. This is a retrospective study of 22 patients with carcinoma lip who underwent surgical resection and reconstruction with sensate nasolabial flap. Several clinicopathological parameters were studied. Outcome parameters like oral competence, tactile sensation, thermal sensitivity of reconstructed lip and speech outcomes were evaluated. A functional outcome with 2-4 mm of two-point discrimination was obtained in 19 patients. All patients had intelligible speech. A mean sulcus depth of 19.59 mm was achieved. One patient had partial flap loss owing to wound infection. Random pattern senate nasolabial flap offers a good functional outcome by maintaining the tactile and thermal sensitivity.

Composite pronator quadratus: radial forearm free flap in functional lip reconstruction.

Reconstruction of lip defects following neoplasia and trauma is a common procedure in plastic surgery. Reconstruction of large lip defects is a difficult undertaking and some degree of residual functional impairment and disability are likely to occur. Microsurgical reconstruction is the recommended technique for large lip defects; however, limitations exist regarding optimal aesthetic and functional outcomes with current free flap options. We propose a new composite flap design based on the innervated pronator quadratus with the radial forearm free flap for a more dynamic reconstruction of total or near total lip defects. Results of our series of four patients have been reviewed. The radial forearm flap - innervated pronator quadratus flap has been used in four patients thus far for lip reconstruction. This flap, in our limited series has shown excellent results in achieving oral competence, good motor function and acceptable cosmetic appearance. The composite radial forearm-pronator quadratus flap is a promising new lip reconstruction technique that has potential to provide a higher level of oral competence, sphincteric function and symmetrical lip movement, than current microsurgical options in dynamic lip reconstruction. This method warrants further investigation in plastic surgery literature.

Aesthetic and Functional Evaluation of Large Full-Thickness Vermilion and Lower Lip Defects Reconstruction.

It is hardly to reconstruct a huge defect of lower lip by using of partial flap which brings no mouth closing functional problem. In this study, we would like to introduce our experience in large full-thickness vermilion and lower lip/chin defects reconstruction, and also focus on the evaluation of the surgery effects. The large lower lip and chin (include vermilion) reconstruction were performed in Sichuan Provincial People's Hospital (2012-2015). The surgery experience was introduced in this study first. In the following section, after a statement of these basic problems, various situations involving are investigated, such as the surgical effects of aesthetic and function that were evaluated through a visual analogue scale (VAS) by doctors and patients separately. The VAS score assessments of 2 kinds of surgery were collected and compared. A total of 7 patients use the tongue flap alone. Four patients use the combination of the free forearm flap and the anterior ventral tongue flap (COMBO flap). The VAS score of doctors group was significantly lower than the patients group (P < 0.05), and the aesthetic appearance was excellent (>90 points). Language features were not affected (>90 points). Slight mouth opening problems exist on these patients who were used COMBO flaps (>80 points; <90 points). The drooling and drumming gas problems were not observed. These 11 patients had no recurrence within 12 months after the operation. The 1:1 ratio between upper and lower lip is crucial to the design of anterior ventral tongue flap which brings with an excellent 3-dimensional morphologic and anatomic structure outcome. The bite block might become an essential operation step for vermilion reconstruction by using of tongue flap. And the COMBO flap may enhance the facial aesthetics and oral function for the reconstruction.

Reconstruction of lip defects: A case series

Reconstruction of lip defects: A case series

Lip reconstruction.

The lips consist of 2 fleshy folds that surround the mouth in humans. They play a dynamic role in facial esthetics, human communications, and oral functions. Defects may result from trauma, malignancy, and congenital disorders. These defects may cause significant alterations of normal lip appearance and function that profoundly impact patients' quality of life. Surgical management of patients in need of lip reconstruction requires a clear understanding of the lip anatomy, aesthetics, and function as well as extensive knowledge and background information of various techniques proposed to this date. This article is a comprehensive review of lip defects reconstruction.

The nasolabial flap as a one-stage procedure for reconstruction of intermediate-to-large lip defects with functional and aesthetic assessments

The primary function of the lip is oral competence. The lips are also fundamental in facial aesthetics. Thus in lip reconstruction, it is paramount to achieve both good functional and aesthetic outcomes. Local flaps are able to provide the best tissue match in intermediate and large lip defects. Nevertheless, there has been limited literature on using the musculocutaneous nasolabial flap as a one-stage procedure for lip reconstruction. The authors recruited 21 patients who underwent a one-stage nasolabial musculocutaneous flap reconstruction for lip defects for the study. The modiolus at the mouth angle was preserved and the nasolabial flap was de-epithelised and tunnelled subcutaneously in all patients for reconstructing the lips. Electromyography was performed for 14 flaps to detect muscle activity. Oral competency was assessed using the Drooling Rating Scale and aesthetic outcomes were also analysed postoperatively with the Patient and Observer Scar Assessment Scale. All patients successfully underwent lip reconstruction with the musculocutaneous nasolabial flap. There were no flap failures. Electromyographic activity was detected in 10 out of the 14 flaps tested. Oral competencies were well preserved and there were no cases of microstomia. Aesthetic results were also good. The nasolabial flap for one-stage reconstruction of lip defects following lip resection is feasible. Good functional and aesthetic outcome can be achieved.

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 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.

Transverse twist flap for lip reconstruction in patient with lentigo maligna of the labial mucosa

The transverse twist flap technique is used for secondary reconstruction of asymmetric volume-deficits of the cleft lip. We present a patient with lentigo maligna of the labial mucosa who underwent reconstruction using this technique. The result was excellent and there was no postoperative complications. The transverse twist flap is a useful and effective option for the reconstruction of lip defects after excision of lentigo maligna.

A detailed observation of variations of the facial artery, with emphasis on the superior labial artery

The reconstruction of lip defects through the use of the Abbe flap and other lip flap procedures involves surgical manipulation of one of the major branches of the facial artery, specifically the superior labial artery (SLA). We examined 284 hemifaces derived from 142 formalin fixed cadavers. Observations regarding the distribution patterns of the facial artery were recognized and categorized into five Types, labeled "A" through "E". Type A (135, 47.5%): facial artery bifurcates into SLA and lateral nasal (the latter gives off inferior and superior alar and ends as angular); Type B (110, 38.7%): similar to Type A, except lateral nasal terminates as superior alar (angular artery is absent); Type C (24, 8.4%): facial artery terminates as SLA; Type D (11, 3.8%): angular artery arises directly from facial arterial trunk rather than as the termination of lateral nasal, with the facial artery ending as superior alar; Type E (4, 1.4%): facial artery terminates as a rudimentary twig without providing any significant branches. Furthermore, we were able to categorize variations within each Type. Sub-Type variations were examined in Types A through C (A: 1-7; B: 1-4; C: 1-3). Our aim was to equip both the anatomist and surgeon with a more thorough understanding of the vasculature of the face, as well as to enable plastic surgeons to have a more confident approach to reconstructive procedures in this region.

Reconstruction of lip defects with lingual membrane flaps

目的 采用舌侧缘瓣移植,修复红唇部缺损畸形.方法对11例红唇部完全或部分缺损患者,根据缺损范围大小制备取蒂在舌尖部的双侧或单侧舌侧缘瓣,转移至红唇部缺损区,2周后断蒂,恢复红唇外形,其中有4例为唇部复合缺损患者,先行红唇部以外复合组织的修复,再行红唇部的修复.有4例红唇缺损范围均超过唇全长1/2,采用了双侧舌瓣修复法,其余7例,红唇缺损范围均小于1/2,则采用单侧舌瓣修复法.结果所有病例,舌瓣全部成活;红唇部外形、色泽及功能恢复较好,无舌运动受限,无感觉及味觉减退等症状.结论采用舌侧缘瓣修复法,尤其是双侧舌瓣修复法,能即时修复红唇部大范围缺损,无需分两次转瓣修复.舌瓣能提供较好颜色和丰满度,在最大程度上保留了舌黏膜乳头,无损于术后舌部的味觉功能;舌部供区隐蔽,术后不留明显畸形,对舌功能影响不大。

Reconstruction of lip defects with the Karapandzic technique.

To study the use and effects of Karapandzic technique of lip reconstruction by long-term assessment. A descriptive study. CMH Rawalpindi from January 1994 to January 2002. Thirty seven consecutive patients who underwent Karapandzic technique of lip reconstruction with a minimum follow-up period of two years have been included. The variables assessed were hemorrhage, wound infection, flap necrosis, microstomia, reconstruction time, hospital stay and dynamic lip functions. Results drawn were analyzed. A total of 37 patients were included in the study. Thirteen (35%) patients were outdoor cases while 24 (65%) were in-patients. Average time of reconstruction was 40 minutes, which was done under general anesthesia in 21(57%) patients and under local anesthesia in 16 (43%) cases. Mean hospital stay of the indoor cases was 26 hours. There was no flap loss except for marginal necrosis in 04 (11%) patients. Wound infection and wound dehiscence was observed in 03 (08%) patients. Sensations were completely intact in 29 (78%) patients and aesthetically 28 (76%) patients gave normal look at the end of two years (2Y). Twenty-seven (74%) patients had no change in speech and only one (3%) patient had unsatisfactory speech after 2 years. Varying degree of microstomia was observed in all the cases at immediate postoperative stage of one month but 35 (95%) patients showed gradual improvement with active mouth opening and stretching by prosthetic splints over 2 years. The Karapandzic technique of lip reconstruction is strongly recommended over the other techniques as it is a single stage, quick and safe procedure which gives cosmetically and functionally excellent results. Microstomia, occurring in early postoperative stage, shows gradual improvement on long-term follow-up.

Mimicking lip features in free-flap reconstruction of lip defects

This paper introduces a technique of lip reconstruction using free flaps in which recognisable landmarks are mimicked by strategic placement of flap junctions. The technique was applied in 15 patients undergoing reconstruction of combined cheek and lip defects using single (n= 9) or double (n= 6) free flaps. Attention to flap design and strategic placement of flap junctions successfully created the vermilion-cutaneous junction, oral commissure and labiomental groove. The presence of these distinguishing features improved the appearance of the reconstructed lip.

Die funktionell und ästhetisch orientierte Rekonstruktion von Lippendefekten

Reconstruction of lip defects presents a challenge to the surgeon. Apart from attaining a good aesthetic result, preserving the function of the oral sphincter is an essential objective. A variety of techniques and modifications of procedures for reconstructing lip defects have been reported in the literature. It is up to the surgeon to select the reconstruction procedure ensuring optimum functional and cosmetic results, depending on the location, size, and depth of the defect. The division of the lips into aesthetic subunits can prove very beneficial in designing lip reconstruction procedures. The upper lip is divided into three aesthetic subunits: two lateral subunits and a median subunit, the philtrum. The lower lip constitutes a single subunit. In this study, established reconstruction techniques are discussed and a concept serving to facilitate the appropriate choice of technique is introduced. This concept differentiates between vermilion defects on the one hand, and partial-thickness and full-thickness lip defects on the other hand. For the lower lip, the full-thickness defects are classified as defects involving one-third, one-third to two-thirds of the lower lip width, and between two-thirds and complete loss of lip tissue. For the upper lip, a distinction is made between isolated defects of the central and lateral subunits and combined defects of the central and lateral subunits. Important principles of surgery and the advantages or disadvantages of different reconstruction techniques are discussed.

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.

Functional and aesthetic objectives in the reconstruction of lip defects.

The reconstruction of lip defects presents a challenge to the surgeon. Apart from attaining a good aesthetic result, preserving the function of the oral sphincter is an essential objective. A variety of techniques and modifications of procedures for reconstructing lip defects have been reported in the literature. It is up to the surgeon to select the reconstruction procedure ensuring optimum functional and cosmetic results, depending on the location, size, and depth of the defect. The division of the lips into aesthetic subunits can prove very beneficial in designing lip reconstruction procedures. The upper lip is divided into three aesthetic subunits: two lateral subunits and a median subunit, the philtrum. The lower lip constitutes a single subunit. In this study established reconstruction techniques are discussed, and a concept serving to facilitate the appropriate choice of technique is introduced. This concept differentiates between vermilion defects on the one hand and partial-thickness and full-thickness lip defects on the other hand. For the lower lip the full-thickness defects are classified as defects involving one third and one third to two thirds of the lower lip width and between two thirds and complete loss of lip tissue. For the upper lip a distinction is made between isolated defects of the central and lateral subunits and combined defects of the central and lateral subunits. Important principles of surgery and the advantages and disadvantages of different reconstruction techniques are discussed.