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.

KEYWORDS

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

REFERENCES

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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.