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Lip flaps. Dr.azimi. Medical Therapy No medical therapy exists for lip loss. Dental prosthetics are ineffective for lip restoration Preoperative Details Flap design includes assessing the size and shape of the defect and the availability of replacement tissue
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Lip flaps Dr.azimi
Medical Therapy • No medical therapy exists for lip loss. • Dental prosthetics are ineffective for lip restoration • Preoperative Details • Flap design includes assessing the size and shape of the defect and the availability of replacement tissue • Prior to administration of anesthetics, mark the cutaneous-vermilion border to aid in realignment and note relevant cosmetic landmarks such as folds, shadows, and tension lines • injection of local anesthetics distorts the normal anatomy. • Oral hygiene should be optimized and hairs trimmed to decrease the chance of infection
Primary closure • Primary repair involves reapproximation of defect edges • relaxed skin tension lines • folds (eg, nasolabial) • most often • a Burow wedge or • V excision based on the vermilion with a 30-degree apex (or an A-to-T flap). • Repair options may include M-plasty or Z-plasty to release tension
commissure Brusaty method
Abbe flap • Used for repair of defects near the oral commissure • One aspect of the flap is incised full-thickness, while the inferiormost aspect of the flap is only excised three-fourths full-thickness to create a pedicle that preserves the vascular supply (labial artery). Three-layer closure is performed • At 3 weeks, the pedicle is separated and the mucosa is repaired or allowed to heal as necessary.
Estlander flap • for repair of defects at the oral commissures. • With a base larger than that of the Abbe flap, the full-thickness incision is placed along the nasolabial fold • A commissureplasty is then performed at 3 months to restore the normal appearance of the angle of the mouth. • A modification to the Estlander flap is the reverse Abbe flap, which avoids revision commissureplasty
Gillies fan flap • for subtotal or total lip reconstruction. • . The flap is rotated to create new commissures while advanced medially to fill the defect • to denervation => sensory loss and vermilion deficiency • preserve partial continuity of the musculature,,
Karapandzic flap • midline medium-sized defects • total lower lip defects • immediate muscle • Three-quarter–thickness incisions are made, and, with separation of muscle fibers allowing for advancement of the flap, the tissue around the defect is reapproximated • microstomia
Bernard-Burow flap • larger lower lip defects using advancement of adjacent cheek tissue • transposition of triangular flaps with bases at the level of the commissures and reconstruct the vermilion using buccal mucosa. • in complete loss of muscle function.
Perialar crescentic advancement flap • scar lies within the perialar and nasolabial folds, allowing for less distortion due to tension ( • a curvilinear incision that naturally follows the nasolabial fold and is generally 3 times larger than the diameter of the defect. • may be combined with an Abbe flap to reconstruct central defects, as well.
Depressor anguli oris flap • repair of lateral lower lip defects • Bilateral flaps allow for repair of larger subtotal lower lip defects
von BrunsNasolabial flap • inferiorly based and rotated around the commissures • total lower lip reconstruction • technique uses bilateral nasolabial tissues and rotates them inferiorly and medially to re-form a complete lower lip • denervation • less than satisfactory oral sphincter function.
Secondary intention • Increase the risk of scar formation • after some Mohs surgeries • superficial defects of the vermilion (eg, after carbon dioxide treatment for actinic cheilitis), • superficial defects of the cutaneous portion of the lip (especially the lateral upper cutaneous lip adjacent to the alar-cheek junction.
distant tissue transfer • distal pedicled flaps deltopectoral, sternocleidomastoid, and pectoralis myocutaneous flaps • microvascular free tissue transfer techniques
total lower lip and chin reconstruction with a composite radial forearm–palmaris longus tendon • lateral antebrachial cutaneous • the palmaris longus tendon suspension and contouring of the flap to re-create the oral sphincter • optimal aesthetic outcome, secondary commissuroplasty may be required
island pedicle flap for cutaneous lip and mucosal advancement flap for vermillion. Bilateral rotation flap
Rotation flap incision line in melolabial fold