If there is a deep wound or hole in the lip, mucosa, or mucus membranes can also be used to fill in the area. Aesthetic upper lip reconstruction with vermilion submucosalpedicle cross lip flap mutsumi okazaki, md, tsuyoshi hisatomi, md,1 shunji sarukawa, md2 tokyo, japan the localized cutaneous amyloidosis occurring on the upper lip of a 48yearold man was surgically treated andaestheticallyreconstructed with vermil. The upper lip is divided into three aesthetic subunits. Stanislaw is an expert at lip reconstruction caused by these conditions. This position should be held only by someone who, along with a thorough knowledge of highway practices, knows the functions, inner workings, and rou tines of the bethlehem highway depart ment. Photograph of the lip defect after wide excision of the squamous cell carcinoma. Lower lip reconstruction strategies introduction the upper and lower lips are the most important functional and aesthetic anatomical structures of the lower seg ment of the face. Upperlip vermilion reconstruction with a modified crosslip. Lip reconstruction can generate a considerable challenge to the plastic surgeon in that the lips are the primary aesthetic and dynamic center of the lower third of the face.
Nasal and upper lip reconstruction of a case of squamous cell. Lower and upper lips are the most important aesthetic and functional structures of the lower segment of the face. Aug 27, 2014 the abbe flap is an excellent choice for reconstruction of fullthickness defects of the lip excluding the oral commissure. Not distorting the commissure is also desirable for upper lip reconstruction. The abbe flap for upper lip reconstruction pubmed central pmc. The lips are a focus of facial beauty, impact in patient self image and their central location does not permit concealment of unsightly scars. The central third of lower lip drains to submental nodes. Functional and cosmetic considerations must be included in any lip or chin reconstruction. Original article outcomes following vy advancement flap.
For more than 100 years, it has remained a versatile technique for upper and lower lip reconstruction, providing good functional and aesthetic results. A neartotal upper lip defect developed, and the flap was designed on the left side first. Seven useful surgical approaches are discussed, and an algorithm to assist in deciding which reconstructive option to use is provided. The abbe flap its use in single and double lip clefts. Total reconstruction of upper lip and columella with bipedicled depressor anguli oris island musculocutaneous flap.
Cleft lip surgery had been performed at 3 months of age. The muscles must be carefully repaired to avoid numbness in the lip. The reconstruction of fullthickness defects of the lower lip can be challenging because the integrity of mucosal, muscular, and cutaneous layers must be reestablished, and in this setting. The patient is a 12yearold boy from vizag in andhra pradesh, india who was born with bilateral cleft lip and palate. Nasolabial flaps, submental flap, and mucosa graft following. Reconstruction of skin cancer defect by sam naficy, md, seattle plastic surgeon. Successful reconstruction of the upper lip attempts to maintain the anatomic relationship of the philtrum central portion of upper lip and the base of the nose. Lymphatic drainage of upper lip and lateral part of lower lip is to the submandibular lymph nodes. The aesthetic or functional abnormalities that prompted revision surgery and the specific techniques. Sep, 2019 upper lip reconstruction with lower lip abbe flap surgery, the patient underwent cleft lip surgery first at 3 months of age. Onestage reconstruction of the large, fullthickness central. Total upper lip reconstruction with a free temporal scalp flap. Reconstruction of an aesthetically acceptable and functional upper lip requires a careful consideration of the transverse and vertical soft tissue, muscle, and skin deficiency. Pdf total upper lip reconstruction with a free temporal.
Luce for this important contribution to further clarify the approaches to upper lip reconstruction. Reconstruction of a lateral upper lip defect italian. Full upper lip reconstruction with bilateral nasolabial flaps. Lip vermilion reconstruction is part of the comprehensive treatment of progressive hemifacial atrophy. No holds barred in supervisor race bethlehem public library. In this study, we described a twostage reconstruction procedure to address the defect of the upper lip in patients with hemifacial atrophy, using a modified cross lip vermilion flap with the pedicle specifically positioned at the commissure for functional and aesthetic purposes. Due to these com plex functions, the reconstruction of lip defects can pose. Division of the left nasolabial flap and the forehead flap was done at the same time figure 6 and figure 7. Sep 17, 2019 the patient is a 12yearold girl from guwahati in assam, india. The nasal defect was closed with an internal mucosal advancement flap, a cartilage graft from concha of the ear, and a paramedian forehead flap for external reconstruction. Even small abnormalities can be apparent because of the prominent location on the face. Upper lip reconstruction special considerations include presence of central structures cupids bow, philtrum in men, facial hair aids in hiding scars in men, nonhairbearing flaps brought into hearbearing areas can be noticeable the upper lip is less important in oral competence more lower.
Onestage reconstruction of the large, fullthickness. Seven useful surgical approaches are discussed, and an algorithm to assist in deciding which reconstructive. Reconstruction of medium to large upper lip defect with a modified unilateral karapandzic flap. Perialar crescentic advancement flap for upper cutaneous lip. Pdf simultaneous total upper and lower lip reconstruction during. Following tumour excision, the average size of the upper lip defect was 35. Lip reconstruction after tumor ablation world journal of plastic. Their role in aesthetic balance, facial expression, speech, and deglutination is not replicated by any other tissue substitute. Lip surgery and reconstructive questions real doctor. The lips contribute to chewing, speech, facial expressions, and oral competence. Oct 20, 2014 surgical instruction upper lip reconstruction for noma by facing africa, nasolabial flap, plastic surgery, flap, sulcus, inner lining, reconstructive surgery, facing africa, flap surgery, incision. Pdf on sep, 2016, arthur charpentier and others published simultaneous total upper and lower lip reconstruction during a humanitarian surgical mission.
Total reconstruction of the upper lip using bilateral nasolabial. In the second stage of the lip reconstruction, cross lip flap abbe was used to restore the symmetry and volume of the upper and lower lips figure 4. A case of upper lip and moustache reconstruction using a submental artery perforator smap flap. Larrabee, jr, md procedure selection for surgical reconstruction of lip defects depends on the location and extent of the defect. Aug 01, 2018 lip defects can be classified according to thickness of the defect ie, skin or mucosa only, fullthickness and overall size of the defect. The marginal artery of the inferior labial artery and fibers of the pars marginalis of the orbicularis muscle are included.
Reconstruction of the lip commissure with upper and lower lip. The fullthickness lip is incised, rotated 180 degrees, and sutured into the upper lip defect in layers, based on an ipsilateral pedicle of posterior vermilion and muscle, at least 0. These flaps of skin are added to the injured lip to restore it. Aesthetic upper lip reconstruction with vermilion submucosal. This is more so when the resection is total and a complete lip has to be constructed.
The procedure used in this case was a combination of bilateral nasolabial flaps with a submental flap and buccal mucosal. Individual patient factors, such as previous operations, underlying comorbidities, compliance, and mechanisms for the wound defect, may affect choices of reconstruction. Griffin and coauthors analyzed larger upper lip skin defects repaired with vy advancement flap reconstruction to identify defect characteristics that might predict the need for revision surgery. Mar 10, 2020 lip reconstruction surgery in these cases typically uses skin grafts. Resection of upper lip adenoid cystic carcinoma and reconstruction.
Upper lip reconstruction with lower lip abbe flap surgery. The volume of the upper lip and mouth opening were sufficient. Lip reconstruction following resection for tumour or following extensive trauma may pose a challenge. Lip reconstruction connecticut stanislawmdstanislawmd. Outcomes following vy advancement flap reconstruction of. The karapandzic flap can be used to resurface up to neartotal defects of both the upper and lower lips, though superiorly based flaps for lower lip defects are. Martin et al 3 reported that plastic surgeons first choice for reconstruction of upper lip defects was the cheek advancement flap, followed by the abbe flap. She was born with a cleft lip and palate along with a cleft alveolus. A clinical study on reconstruction of lip defects international. A sidetoside or complex linear closure is an excellent alternative for small defects on the upper or lower lip figs. Lip reconstruction requires familiarity with the surface anatomy, underlying muscular anatomy, and neurovascular anatomy of the lower face.
New technique of onestage reconstruction of a large fullthickness defect in the upper lip. Reconstruction of upper lip with lower lip abbe flap youtube. The division of the lips into aesthetic subunits can prove very beneficial in designing lip reconstruction procedures. Two lower lip defects were reconstructed with estlander. The defect of the upper lip was covered with a fan flap with incorporation of zplasty flap. We present a case of lip reconstruction following a total resection of the upper lip. The abbeestlander flap is a fullthickness lipswitch flap in which a portion of the uninvolved lip upper or lower is rotated across the mouth and into the defect of. The upper lip is composed of the philtrum and tubercle centrally, the paired philtral columns laterally, and the white roll of the vermiliocutaneous junction. We reserve the abbe flap for transfixant philtrum and medial defects that cannot be reconstructed by direct closure, 1 as described previously. Reconstruction of the lip commissure with upper and lower lip fullthickness defects using submental and nasolabial flaps.
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