Lip Reconstruction

ABSTRACT

Lip reconstruction poses a particular challenge to the plastic surgeon in that the lips are the dynamic center of the lower third of the face. Their role in aesthetic balance, facial expression, speech, and deglutination is not replicated by any other tissue substitute. The goals of lip reconstruction are both functional and aesthetic, and the surgical techniques employed are often overlapping. This discussion will focus on lip defects with significant tissue loss that require flap reconstruction. Flaps described include Webster-Bernard cheek advancement flaps, Abbe cross-lip flaps, Karapandzic rotation advancement flaps, and single and dual free-flap lip reconstructions. The principles and techniques described are broadly applicable to other flap designs that are required to meet both the aesthetic and functional goals of lip reconstruction.

Lip reconstruction - Webster-Bernard flap - Abbe flap - Karapandzic flap - free flap

REFERENCES

• 1 Adams W, Beran S. Lip, cheek, and scalp reconstruction; hair replacement.  Selected Readings in Plastic Surgery. 2001;  15 2-16
• 2 Kroll S. Lip reconstruction. In: Kroll S Reconstructive Plastic Surgery for Cancer. St. Louis, MO; Mosby Year Book 1996: 201-209
• 3 Webster R C, Coffey R J, Kelleher R E. Total and partial reconstruction of the lower lip with innervated muscle-bearing flaps.  Plast Reconstr Surg Transplant Bull. 1960;  25 360-371
• 4 Closmann J J, Pogrel M A, Schmidt B L. Reconstruction of perioral defects following resection for oral squamous cell carcinoma.  J Oral Maxillofac Surg. 2006;  64 367-374
• 5 Langstein H N, Robb G L. Lip and perioral reconstruction.  Clin Plast Surg. 2005;  32 431-445
• 6 Karapandzic M. Reconstruction of lip defects by local arterial flaps.  Br J Plast Surg. 1974;  27 93-97
• 7 Civelek B, Celebioglu S, Unlu E, Civelek S, Inal I, Velidedeoglu H V. Denervated or innervated flaps for the lower lip reconstruction? Are they really different to get a good result?.  Otolaryngol Head Neck Surg. 2006;  134 613-617
• 8 Salgarelli A C, Sartorelli F, Cangiano A, Collini M. Treatment of lower lip cancer: an experience of 48 cases.  Int J Oral Maxillofac Surg. 2005;  34 27-32
• 9 Jeng S F, Kuo Y R, Wei F C, Su C Y, Chien C Y. Total lower lip reconstruction with a composite radial forearm-palmaris longus tendon flap: a clinical series.  Plast Reconstr Surg. 2004;  113 19-23
• 10 Sadove R C, Luce E A, McGrath P C. Reconstruction of the lower lip and chin with the composite radial forearm-palmaris longus free flap.  Plast Reconstr Surg. 1991;  88 209-214
• 11 Granick M S, Newton E D, Hanna D C. Scapular free flap for repair of massive lower facial composite defects.  Head Neck Surg. 1986;  8 436-441
• 12 Giessler G A, Cornelius C P, Suominen S et al.. Primary and secondary procedures in functional and aesthetic reconstruction of noma-associated complex central facial defects.  Plast Reconstr Surg. 2007;  120 134-143
• 13 Yildirim S, Gideroglu K, Aydogdu E, Avci G, Akan M, Akoz T. Composite anterolateral thigh-fascia lata flap: a good alternative to radial forearm-palmaris longus flap for total lower lip reconstruction.  Plast Reconstr Surg. 2006;  117 2033-2041
• 14 Jeng S F, Kuo Y R, Wei F C, Su C Y, Chien C Y. Reconstruction of concomitant lip and cheek through-and-through defects with combined free flap and an advancement flap from the remaining lip.  Plast Reconstr Surg. 2004;  113 491-498
• 15 Yamauchi M, Yotsuyanagi T, Yokoi K, Urushidate S, Yamashita K, Higuma Y. One-stage reconstruction of a large defect of the lower lip and oral commissure.  Br J Plast Surg. 2005;  58 614-618
• 16 Jeng S F, Kuo Y R, Wei F C, Su C Y, Chien C Y. Reconstruction of extensive composite mandibular defects with large lip involvement by using double free flaps and fascia lata grafts for oral sphincters.  Plast Reconstr Surg. 2005;  115 1830-1836
• 17 Cordeiro P G, Santamaria E. Primary reconstruction of complex midfacial defects with combined lip-switch procedures and free flaps.  Plast Reconstr Surg. 1999;  103 1850-1856
• 18 Ninkovic M, di Spilimbergo S S, Ninkovic M. Lower lip reconstruction: introduction of a new procedure using a functioning gracilis muscle free flap.  Plast Reconstr Surg. 2007;  119 1472-1480
• 19 Ueda K, Oba S, Ohtani K, Amano N, Fumiyama Y. Functional lower lip reconstruction with a forearm flap combined with a free gracilis muscle transfer.  J Plast Reconstr Aesthet Surg. 2006;  59 867-870
• 20 Pribaz J J, Fine N, Orgill D P. Flap prefabrication in the head and neck: a 10-year experience.  Plast Reconstr Surg. 1999;  103 808-820
• 21 Pribaz J J, Meara J G, Wright S, Smith J D, Stephens W, Breuing K H. Lip and vermilion reconstruction with the facial artery musculomucosal flap.  Plast Reconstr Surg. 2000;  105 864-872
• 22 Kim J C, Hadlock T, Varvares M A, Cheney M L. Hair-bearing temporoparietal fascial flap reconstruction of upper lip and scalp defects.  Arch Facial Plast Surg. 2001;  3 170-177

Editor's Comments

Drs. Baumann and Robb have written an outstanding review of their reconstructive management of large lip defects.

They reflect the current consideration that the upper limits of a lip defect to be closed primarily is limited to 30%.

However, we have found that in selected patients defects up to 45% can be closed with a “V” wedge incision closure. The resulting lip is functional, but admittedly unbalanced. Overall, we still feel this provides the best functional resection option.

Also, for upper lip skin only defects, peri-alar crescentric advancement flap can provide color matched coverage of up to 35% defects in selected patients.

James F. Thornton, M.D.

Figure 1 Interoperative/postoperative views of a nearly 50% lower lip defect closed by wedge excision/closure.

Figure 2 30% skin only upper lip defect reconstructed with a peri-alar crescentric advancement flap.