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